International Journal of Periodontics & Restorative Dentistry, 02/2018

The goal of this investigation was to evaluate the bone-to-implant contact (BIC) of dental implants placed into fresh extraction sockets without pre-existing periapical pathology. When the extraction sites exhibited a gap distance of > 2 mm, autogenous bone harvested from surrounding surgical sites was grafted to fill that gap with no barrier membranes. All implants were clinically stable and successful at 6 months postoperative. The histologic examination demonstrated an average of 66.2% BIC for all five immediately placed dental implants. The results of this study provided sufficient histologic and histomorphometric knowledge to support immediate dental implant placement in carefully selected clinical scenarios.

The aim of this study was to compare customized zirconia and titanium abutments with respect to survival rates and technical, biologic, and esthetic outcomes. A total of 28 patients with single implants were randomly assigned to 12 customized zirconia (test, AC) and 16 customized titanium (control, MC) abutments. Technical, biologic, and esthetic outcomes were assessed after a mean follow-up time of 18 months. No biologic complications were observed, and no statistical difference for the bone-to-implant distance was found at 18 months (AC −0.05 ± 0.51 mm vs MC −0.28 ± 0.77 mm; P = .40). A similar discoloration of the peri-implant mucosa was observed (ΔEAC 9.6 ± 5.4, ΔEMC 7.6 ± 5.3; P = .46). The mean papilla score values evaluation presented no statistically significant differences between the test and control groups (AC 2.07 ± 0.94, MC 1.96 ± 0.84). At 18 months, reconstructions based on zirconia and titanium abutments exhibited similar survival rates and similar clinical outcomes.

The aim of this retrospective study was to examine the histories of 100 patients with 170 implants that were consecutively treated and reported in a previous study to identify which patient and implant factors might have affected the outcomes of therapy. Patient factors included history of periodontitis, hypertension, cardiac problems, rheumatoid arthritis, smoking, and penicillin allergy. Implant factors included whether the prosthesis was cemented or screw retained and initial bone loss (≤ 50% or > 50% of implant length). Frequency of maintenance visits (≤ 3 months or > 3 months) were recorded, as was patient age (≤ 60 years or > 60 years). On the patient level, only postoperative maintenance (≤ 3 months) showed a statistically significant effect on radiographic bone gain (RBG) compared to patients with > 3 months maintenance frequency. Nondiabetic patients showed a trend toward soft tissue gain. On an implant level, screw-retained prostheses demonstrated a statistically significant RBG compared to those with cement-retained prostheses. Significant favorable differences were seen in all outcomes when evaluating presurgical bone level loss (> 50% of the implant length). Further studies with larger groups of patients are necessary to substantiate the findings in this report.

Treatment of tooth wear has increased over the last two decades. However, the treatments involved have not been satisfactory to most patients, nor have they achieved the expected goal on some worn teeth. New approaches have emerged to reconstruct full arches in a minimally invasive way that take advantage of developments in the field of adhesive dentistry. These new concepts constitute a revolution in dentistry and their application requires adapted techniques and training. The purpose of this article is to suggest a precise and reproducible method that simplifies the treatment of worn dentition. A wax-up and a mock-up are primarily used to design the esthetic outcome and then used as a guide for the preparation of anterior teeth or the occlusal surfaces of posterior teeth. This not only provides the exact new vertical dimension of occlusion but serves as a guide for precisely controlling occlusal preparation simultaneously with buccal preparation. The classical cavity design for a partial bonded restoration on posterior worn dentition is also reviewed. The authors believe that during the preparation of the occlusal surfaces of the posterior teeth surfaces, the marginal ridges must be preserved to reduce the biologic cost and mechanical stress leading to fracture. A new type of thin and reduced restoration called tabletop is presented.

The aim of this study was to evaluate a new minimally invasive surgical technique for the reconstruction of critical-size bony defect with local harvested bone core with simultaneous implant placement. In a prospective study, 186 consecutively treated patients were included and controlled clinically and radiologically for at least 5 years postoperative. Every patient presented a bony defect affecting the buccal, lingual, or palatal wall. In all cases, the alveolar crest was wide enough to allow implant placement inside the bony contours. During implant bed preparation, a trephine bur (3.5 mm external diameter and 2.5 mm internal diameter) was used to harvest a bone core from the socket. After implant insertion, the buccal/palatal/lingual bony defect was grafted with bone chips covered with the bone core stabilized through compression with microscrews. After 3 months of healing, the implants and the grafted bone were exposed and the width of the grafted area was measured. After prosthetic restoration, the patients were recalled regularly. A total of 223 grafted sites were documented. Minor primary healing complications were observed in 3 sites (1.4%), all in smoker patients, and were treated locally without any influence on the prognosis. All other sites healed uneventfully. In 19 cases (4.4%), exposure of the screw heads was detected 1 to 3 months postoperatively without any inflammation or consequences for the grafted bone. The average width of the reconstructed area at the end of the grafting procedure was 2.4 ± 0.8 mm, and at the reentry, 2.1 ± 0.6 mm. There was a difference of remodeling between bone cores grafted totally inside or partially outside the bony contours. Bone cores grafted completely inside the bony contours demonstrated no resorption at 3 months postoperative, while bone cores grafted partially outside the bony contours in most cases showed partial resorption of the bone outside the bony contours. After 3 months of healing, all 223 implants had achieved primary healing and osseointegration and were restored after an average time of 4 months. No implant failed during the control period. According to this study, the use of an autogenous bone core harvested during the implant bed preparation is a simple and safe method for the reconstruction of small bone defects.

Full-arch fixed implant-supported prostheses have shown high biologic success rates after long-term follow-up, along with technical and prosthetic complications. Adequate planning is necessary for immediate implant occlusal loading in a completely edentulous maxilla or mandible. For totally edentulous patients, the main prosthetic problem is the transfer of diagnostic information to the master cast when an immediate loading approach is used. The aim of this clinical case report is to illustrate a new prosthetic protocol for immediate implant loading in edentulous or potentially edentulous patients. This innovative procedure can successfully guide the clinician step by step in a predictable way from diagnosis to delivery of an immediately loaded implant-supported full-arch rehabilitation.

Advanced periodontal disease is often associated with severe loss of tooth support, necessitating prosthetic rehabilitation to restore function and esthetics. For tooth-supported restorations, periodontally compromised teeth may need to be extracted due to early failure from functional overload. For tooth/ implant-supported restorations, implants can be used to reduce the overload on teeth and to avoid tooth extraction, bone augmentation, or other risks associated with implant placement. The aim of this retrospective study was to evaluate the long-term outcomes of full-arch, retrievable, telescopic-retained prostheses (TRPs) on teeth and implants according to survival rate analyses and technical and biologic complications in full-mouth rehabilitation of periodontally compromised dentitions. A total of 18 periodontally compromised patients (7 women, 11 men) with a mean age of 46.8 years (SD: 6.3 years; range: 32 to 64 years) were selected to receive supplementary implants with the aim of extensive prosthetic support in combined tooth/implant TRPs and annually evaluated for technical and/or biologic failures/complications. After a followup period of 15 years, all prostheses were in function. Complication rates were low, and maintenance services were limited to minor interventions. Combined tooth/implant TRPs improve prosthetic support and offer successful function over the long term in patients with periodontally compromised dentition.

While creeping attachment in natural teeth has been reported in the literature for decades, the same phenomenon around dental implants is a new concept. This article describes two implant cases treated with free gingival autograft with followup at 18 and 30 months. Progressive coronal creeping of the mucosal margin was observed covering the implant and abutment surfaces postoperatively. This report demonstrates that mucosal creeping around implants may occur after peri-implant plastic surgical procedures, further improving the final outcomes of therapy.

The aim of this study was to assess bone and soft tissue changes after tooth extraction and immediate implant insertion in the anterior maxilla. A novel synthetic bone graft (VivOss, Straumann) was used to fill the gap between the implant surface and the alveolar bone. Implants with a reduced diameter compared to the size of the socket were used. A fixed or removable provisional restoration was provided immediately after implant placement. Cone beam computed tomography (CBCT) scans were taken to evaluate bone changes, showing minor variations after 12 months of follow-up. To evaluate soft tissue changes, clinical vertical measurements were performed. Based on the results obtained from 15 implants placed in 14 patients, it can be concluded that the use of an immediate implant in combination with a synthetic bone graft and immediate provisionalization seems to be a predictable treatment option with satisfactory esthetic results after 1 year.

The purpose of the present study was to evaluate the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique with collagen membrane, bioactive glass, and platelet-rich fibrin. A total of 22 systemically and periodontally healthy subjects with multiple gingival recession defects (Miller Class I and II) in the maxillary esthetic zone were enrolled in the study. The primary outcome measures were mean root coverage and alteration in gingival thickness. There were no surgical complications; however, one patient reported swelling of the upper lip area on the first postoperative day, which resolved spontaneously. A statistically significant increase in gingival thickness (0.45 mm) and 94.17% ± 8.42% mean root coverage was observed at 18 months. Within the limitations of this study, it was concluded that the VISTA technique augmented with collagen membrane, bioactive glass, and plateletrich fibrin is a predictable modality in multiple recession management.

A case of squamous cell carcinoma of the gingiva (GSCC) in the left anterior maxilla in a 64-year-old woman that was treated for almost 5 years as suspected periodontal lesion prior to establishing the final diagnosis of oral cancer is presented in this case report. GSCCs have a variable clinical appearance, ranging from an exophytic mass to ulcerative lesions. They have been reported to pose a diagnostic challenge and are not infrequently initially misdiagnosed as periodontal disease. A delay in diagnosis and extraction of teeth in the vicinity of GSCCs has been demonstrated to increase the risk for lymph node metastasis and thus result in a lower 5-year survival rate. To avoid misdiagnosis and delay of the appropriate treatment, a proper histopathologic evaluation is mandatory whenever an incisional biopsy is performed. Furthermore, referral to a specialist in oral medicine or oral and maxillofacial surgery is indicated when a gingival lesion is nonresponsive to treatment, recurring, or rapidly growing in size.

This in vitro pilot study was performed to determine whether a treatment algorithm including mechanical debridement, followed by air powder abrasion with glycine, followed by citric acid conditioning with vigorous flushing of the surface with sterile water after each step, is capable of decontaminating an infected implant surface. A total of 14 dental implants that were deemed hopeless due to advanced peri-implantitis were extracted. Of these, 6 implants served as tests and had their exposed surfaces treated with the decontamination protocol, 6 served as untreated controls, and 2 were mechanically treated only, followed by rubbing the surface with sterile saline. All implants were placed in culture with human osteoprogenitor cells for 72 hours, and evaluation was performed using scanning electron microscopy. The 6 test implants all demonstrated attachment and proliferation of the normal human osteoprogenitor cells on their prior exposed and decontaminated surfaces. All of the untreated control and the mechanically debrided, sterile water-treated implants failed to demonstrate this same success. The results suggest that this protocol can decontaminate an implant surface affected by peri-implantitis. Further studies are warranted to determine if this technique would demonstrate similar success over a greater number of implants and whether this outcome may occur in humans.

Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed ( 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patientrelated factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.

The conometric retention system was proposed and described as a predictable alternative to retain fixed implant-supported complete dentures and, more recently, to retain fixed partial restorations. Currently available studies describe a technique based on the Ankylos (Dentsply) implant system and stock conic coupling abutments. The purpose of this case series study is therefore to demonstrate the possibility of using Atlantis computer-aided design/ computer-assisted manufacture technology to produce Conus abutments (Dentsply) and using the fixed conometric retention with other implant brands for which appropriate stock conic coupling abutments are not available.

The aim of the present survey was to define the most appropriate recall regimen and professional maintenance care protocol, identifying the main relative issues, based on a consensus of experts with long-term clinical experience. The survey consisted of 14 clinically relevant focused questions. The answers of each expert were aggregated to formulate clinical recommendations. The maintenance care protocol must be individually determined and a baseline condition identified. The recall frequency must have a specific periodicity, and bone levels must be radiographically checked at least every 2 years, unless specific needs require a shorter interval.

A systematic literature review was performed regarding the accuracy and usefulness of cone beam computed tomography (CBCT) in the field of periodontology. A total of 580 articles were identified, of which 13 met the inclusion criteria. Results showed a high accuracy of CBCT in visualizing periodontal structures and the demonstrated the usefulness of CBCT in regenerative periodontal surgery of maxillary molars. It remains questionable whether this gain of additional information actually leads to a better clinical outcome in periodontal treatment. Currently, the use of CBCT in periodontology should be restricted to complex periodontal cases, particularly those involving maxillary molars.

This article describes a simplified technique for relining provisional prostheses on natural abutments that can be applied to this specific type of tooth preparation with feather-edge finish line. Starting from a diagnostic waxup, a provisional fixed restoration is constructed, containing all the correct structural information. This includes the controlled depth of the prosthetic margin into the gingival sulcus, the emergence profile, and the area from the emergence profile to the gingival third. Chair time is saved during the clinical procedures because the finishing and polishing steps are shortened, and the resulting provisional restoration is precise and highly biocompatible. This technique allows for a simple and quick relining and finishing procedure and for the delivery of an esthetic and biocompatible provisional restoration.

This report describes a failed blade implant after 25 years in function in the left maxilla and the results of histologic analysis of peri-implant tissues. The blade was retrieved, and histologic findings revealed that it was not osseointegrated despite being successfully in function for so many years. The long-term function of blade implants without osseointegration can be attributed to biotolerance exhibited by the implant rather than actual osseointegration.