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Maurice Salama, DMD, is a clinical assistant professor of periodontics at the Medical College of Georgia. He is a permanent member of the Scientific Committee of the world’s leading online dental education website, DentalXP.com. He is also a member of the Team Atlanta Dental Practice, a multidisciplinary practice world renowned for clinical research in reconstructive and esthetic dentistry.
Events
The 14th International Symposium on Periodontics and Restorative Dentistry (ISPRD)
9. Jun 2022 — 12. Jun 2022Boston Marriott Copley Place, Boston, MA, United States of America
Speakers: Tara Aghaloo, Edward P. Allen, Evanthia Anadioti, Wael Att, Vinay Bhide, Markus Blatz, Scotty Bolding, Lorenzo Breschi, Jeff Brucia, Daniel Buser, Luigi Canullo, Daniele Cardaropoli, Stephen J. Chu, Donald Clem, Christian Coachman, Lyndon F. Cooper, Daniel Cullum, Lee Culp, Sergio De Paoli, Marco Degidi, Nicholas Dello Russo, Serge Dibart, Joseph P. Fiorellini, Mauro Fradeani, Stuart J. Froum, David Garber, Maria L. Geisinger, William Giannobile, Luca Gobbato, Ueli Grunder, Galip Gürel, Chad Gwaltney, Christoph Hämmerle, Robert A. Horowitz, Marc Hürzeler, David Kim, Gregg Kinzer, Christopher Köttgen, Ina Köttgen, Purnima S. Kumar, Burton Langer, Lydia Legg, Pascal Magne, Kenneth A. Malament, Jay Malmquist, George Mandelaris, José Carlos Martins da Rosa, Pamela K. McClain, Michael K. McGuire, Mauro Merli, Konrad H. Meyenberg, Craig M. Misch, Julie A. Mitchell, Marc L. Nevins, Myron Nevins, Michael G. Newman, Miguel A. Ortiz, Jacinthe M. Paquette, Stefano Parma-Benfenati, Michael A. Pikos, Giulio Rasperini, Pamela S. Ray, Christopher R. Richardson, Isabella Rocchietta, Marisa Roncati, Marco Ronda, Paul S. Rosen, Maria Emanuel Ryan, Irena Sailer, Maurice Salama, David M. Sarver, Takeshi Sasaki, Todd Scheyer, Massimo Simion, Michael Sonick, Sergio Spinato, Dennis P. Tarnow, Lorenzo Tavelli, Douglas A. Terry, Tiziano Testori, Carlo Tinti, Istvan Urban, Hom-Lay Wang, Robert Winter, Giovanni Zucchelli
Quintessence Publishing Co., Inc. USA
This author's journal articles
International Journal of Periodontics & Restorative Dentistry, 5/2023
DOI: 10.11607/prd.6127, PubMed ID (PMID): 37338918Pages 571-577, Language: EnglishBishara, Mark / Wu, David T / Miron, Richard J / Nguyen, Thomas T / Sinada, Naif / Gluckman, Howard / Salama, Maurice
Partial extraction therapy (PET) is a group of surgical techniques that preserve the periodontium and peri-implant tissues during restorative and implant therapy by conserving a portion of the patient’s own root structure to maintain the blood supply, derived from the periodontal ligament complex. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). Although their clinical success and benefits have been demonstrated, several studies report possible complications. The focus of this article is to highlight management strategies for the most common complications associated with PET, including internal root fragment exposure, external root fragment exposure, and root fragment mobility.
International Journal of Periodontics & Restorative Dentistry, 4/2023
DOI: 10.11607/prd.5859, PubMed ID (PMID): 37552191Pages 443-449, Language: EnglishBishara, Mark / Sinada, Naif / Wu, David T. / Miron, Richard J. / Karateew, Dwayne / Gluckman, Howard / Salama, Maurice
Partial extraction therapy (PET) is a set of surgical techniques that preserve a portion of the patient’s own root structure to maintain blood supply derived from the periodontal ligament complex in order to maintain the periodontium and peri-implant tissues during restorative and implant therapy. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). In a traditional hybrid technique, total extraction and full-arch dental implant therapy often require significant bone reduction and palatal/lingual implant placement. In addition, postextraction preservation of the ridge architecture is a major challenge. This case series demonstrates the use of a combination of PET techniques with digital implant planning and guided implant surgery to achieve highly esthetic outcomes in full-arch implant therapy.
In seiner klassischen Form erstreckt sich ein Socket Shield von der mesio- zur distolabialen Kante des Zahns. C-förmige, L-förmige und approximale Socket-Shield-Designs besitzen approximale Extensionen, die den Hart- und Weichgewebeerhalt in den Approximalbereichen unterstützen. Dies bietet besondere Vorteile für Implantatstellen neben einem bereits vorhandenen Implantat oder einer Zahnlücke. Häufigste Komplikation der Socket-Shield-Technik (SST) ist die interne Exposition des Schilds. Aufgrund anatomischer Gegebenheiten, wie einer bogenförmigen Kammkontur und der ovalen Alveolenform einiger Zähne, erhöht sich das Risiko für eine interne Exposition, unbemerkte Verschiebung oder Fraktur des Schilds während der Implantatsetzung in den approximalen Schildbereichen. Im vorliegenden Beitrag werden Richtlinien für die Indikation der approximalen Schildextension, die Socket-Shield-Präparation sowie die Auswahl der Implantat- und prothetischen Komponenten vorgestellt.
The conventional socket shield (SS) design extends from the mesiolabial to the distolabial line angle. C-shaped SS, L-shaped SS, and proximal SS designs have proximal extensions that help to maintain the hard and soft tissue in the interproximal areas. This is beneficial for implant sites adjacent to an existing implant or an edentulous space. The most common complication of the socket shield technique (SST) is internal shield exposure. Due to anatomical features such as a scalloped ridge shape and an oval socket shape of some teeth, the risk of complications such as internal shield exposure, inadvertent SS displacement, and fracture of the SS during implant insertion is greater in proximal shield areas. The present article describes guidelines for case selection for proximal shield extensions, along with SS preparation and the selection of implant and prosthetic components.
International Journal of Esthetic Dentistry (EN), 4/2021
PubMed ID (PMID): 34694081Pages 580-592, Language: EnglishGluckman, Howard / Pontes, Carla Cruvinal / Du Toit, Jonathan / Coachman, Christian / Salama, Maurice
Background: The characteristics of the periodontium in anterior teeth influence the outcomes and prognosis of different periodontal, implant, and restorative procedures. In the present study, CBCT images were used to determine alveolar bone thickness and, to a lesser extent, gingival thickness. The aim was to evaluate the use of CBCT to measure the dentogingival complex in the anterior maxilla.
Materials and methods: CBCT scans from 25 healthy patients were taken and the maxillary anterior teeth (n = 138) analyzed in the radial plane. The study provided descriptive data on gingival thickness, alveolar bone thickness (horizontal measurements), and vertical measurements related to biologic width.
Results: The mean distance from gingival margin to bone crest (BC) was 3.4 ± 0.7 mm, and that between the cementoenamel junction and BC was 2.6 ± 1.0 mm. The average mid-labial gingival thickness 1 mm apical of the gingival margin was 1.0 ± 0.3 mm; a thinner gingiva was observed in females (P = 0.01) and canines (P < 0.001). The average crestal labial bone thickness was 0.8 ± 0.3 mm. In total, 62% of the tooth sites had a thin gingiva (< 1 mm), and 72% had thin labial bone plates; a moderate positive correlation was found between these parameters (P < 0.001).
Conclusions: CBCT was effective in providing data on the thickness of the labial plate and gingiva as well as on the relationship among BC, CEJ, and gingival margin. The majority of tooth sites had thin labial bone and thin gingiva, with thinner gingiva observed in females and at canine sites.
In the maxillary anterior region, augmentation to correct a soft tissue deficiency is often required for an esthetic outcome and long-term implant therapy success. This case series of three patients presents a novel approach for soft tissue augmentation using xenogeneic collagen matrix balls in the esthetic zone around the implants. This technique avoids a secondary donor site compared to autogenous connective tissue graft. With this technique, a horizontal soft tissue volume increase (range: 3 to 5 mm) was observed postsurgically and maintained at later follow-ups. The described ball technique offers a viable method for peri-implant mucosal augmentation in the maxillary anterior region.
Hintergrund: Die Eigenschaften des Parodonts der Frontzähne beeinflussen das Ergebnis und die Prognose verschiedener parodontologischer, implantologischer und restaurativer Behandlungsmaßnahmen. In der vorliegenden Studie wurden DVT-Aufnahmen verwendet, um die Alveolarknochendicke und, in geringerem Umfang, die Gingivadicke zu bestimmen. Ziel war es, zu prüfen, ob die digitale Volumentomografie als Möglichkeit für die Vermessung des dentogingivalen Komplexes im Oberkiefer-Frontzahnbereich infrage kommt.
Material und Methode: Von 25 gesunden Patienten wurden DVT-Aufnahmen erstellt und die Oberkiefer- Frontzähne jeweils in der Radialebene analysiert (n = 138). Die Auswertung lieferte deskriptive Daten zur Gingivadicke, (horizontalen) Alveolarknochendicke und biologischen Breite (vertikale Messungen).
Ergebnisse: Der mittlere Abstand vom Gingivarand zum Knochenkamm betrug 3,4 ± 0,7 mm, der Abstand zwischen der Schmelz-Zement-Grenze (SZG) und dem Knochenkamm 2,6 ± 1,0 mm. Die durchschnittliche mediolabiale Gingivadicke 1 mm apikal des Gingivarands lag bei 1,0 ± 0,3 mm. Bei Frauen (p = 0,01) und an Eckzähnen (p < 0,001) war die Gingiva dünner. Die durchschnittliche krestale Knochendicke betrug 0,88 ± 0,3 mm. Insgesamt wiesen 62 % der Zahnstellen eine dünne Gingiva (< 1 mm) und 72 % eine dünne vestibuläre Knochenwand auf. Zwischen diesen Parametern fand sich eine moderate positive Korrelation (p < 0,001).
Schlussfolgerung: Ein DVT kann Daten zur Dicke der labialen Knochenwand und Gingiva sowie zur Lagebeziehung zwischen Knochenkamm, SZG und Gingivarand liefern. Die Mehrzahl der gemessenen Zahnstellen hatte dünnen labialen Knochen und dünne Gingiva, wobei an Eckzähnen und bei Frauen geringere Gingivadicken beobachtet wurden.
One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.
Seit der Einführung der Socket-Shield-Technik durch Hürzeler und Mitarbeiter sind 10 Jahre vergangen. Seitdem hat sich viel weiterentwickelt bei dieser partiellen Extraktionstherapie, bei der die eigene Zahnwurzel des Patienten zum Erhalt des Parodonts und periimplantären Gewebes eingesetzt wird. Im vorliegenden Artikel werden Spezifikationen, Arbeitsschritte, Instrumente und Verfahren diskutiert, die das Ergebnis umfangreicher Erfahrungen bei der Verfeinerung der Socket-Shield-Technik sind, wie wir sie heute kennen. Ein zuverlässiges und reproduzierbares Protokoll ist eine zwingende Voraussetzung für den Ersatz eines Zahns in der ästhetischen Zahnmedizin. Zudem hilft das standardisierte Protokoll dabei, prozedural konsistente Daten zu dieser Technik zu publizieren. Erläutert wird ein reproduzierbares Schritt-für-Schritt-Protokoll für die Socket-Shield-Technik bei einer Sofortimplantation mit Sofortprovisorium als Ersatz für einwurzelige Zähne.
Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient's own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket-shield technique at immediate implant placement and provisionalization for single-rooted teeth.