International Journal of Periodontics & Restorative Dentistry, 01/2007

Consecutively restored scalloped dental implants were evaluated radiographically and clinically. Radiographic evaluation of 16 two-piece scalloped implants and 9 one-piece scalloped implants revealed enhanced interproximal bone levels versus a nonscalloped conventional flat-top implant design. Based on the Jemt system for interproximal soft tissue level evaluation, 78% of the two-piece implants scored a 3 and 22% scored a 2, and 89% of the one-piece implants scored a 3 and 11% scored a 2. Enhanced interproximal tissue preservation from scalloped implant designs may lead to more predictable esthetic dental implant restorations in the anterior maxilla.

The purpose of the present study was to evaluate a novel surgical procedure: the interproximally connected flap. This technique is intended to prevent membrane exposure by maintaining the integrity of the interproximal soft tissues in the treatment of deep intrabony defects, in conjunction with the use of nonresorbable barrier membranes, thereby increasing the space for hard and soft tissue regeneration. Eleven patients (11 defects) were treated with this new flap design, which avoided any type of incisions in the interproximal tissues of the defect-associated papillae. Primary closure over the titanium-reinforced membrane was achieved in 100% of defects at baseline, with no exposures occurring during the 4-month healing period. The difference between baseline and 1-year probing pocket depths and probing attachment levels was clinically significant.

Because osseointegration is now considered highly predictable, the current trend is to develop techniques that can provide function, esthetics, and comfort with a minimally invasive surgical approach. To achieve those goals, flapless implant surgery using a tissue punch technique has been suggested. This paper presents two clinical cases of single-tooth implants placed in the esthetic region (anterior maxilla), which illustrate systematic approaches to flapless implant surgery for immediate and delayed loading protocol. For both cases, a tissue punch technique using a surgical guide fabricated with the aid of a radiographic stent was performed to provide access for implant site preparation and placement. The implants were loaded either immediately or 4 months after implant placement. With the planned flapless surgical technique, reduced operative time, accelerated postsurgical healing, and increased patient comfort and satisfaction were achieved. This paper also describes precautions of the flapless implant surgery in case selection, surgical techniques, and prosthodontic protocol. In conclusion, appropriate case selection and well-tailored surgical guides with sound surgical and prosthodontic protocols are considered to be the key elements in the success of flapless implant surgery.

Precision telescopic attachments allow for rigid connection between removable prostheses and abutments. However, it is still unknown whether implants can bear similar long-term loading forces as teeth when telescopic crowns are used as retention devices. It was the aim of this prospective clinical study to observe maxillary removable partial dentures that were retained by telescopic crowns on two endosseous implants in the canine regions. In a control group, identical dentures were fabricated that were retained by telescopic crowns on the maxillary canines. The implant group consisted of 14 patients, and the control group included 8 patients. Mean observation time of the prostheses was 25.6 months. Radiographic bone levels and periodontal parameters did not reveal specific differences between the two groups. However, five implants failed, and there were no failures in the control group. Survival rates were 48.9% for the implant group and 100% for the control group, with a significant difference between the two groups. Within the limits of this study, it is concluded that the telescopic connection might be too rigid (thus delivering overloading) for two single implants in the canine region of the maxilla supporting a removable denture.

The aim of this report was to illustrate the preliminary results using standard dental implants as palatal anchorage for orthodontic movement in children and adults. Three teenagers and one adult received six conventional Brånemark dental implants (6 to 7 mm long) in their palates. The planned therapeutic goals were achieved in every case; however, around two implants, mucosal hyperplasia developed. In one case the hyperplasia was noticed in conjunction with a loosened abutment. The use of conventional dental implants in palatal locations may provide good results, but the efficacy and potential advantages of this treatment must be evaluated in properly designed clinical trials.

The aim of this investigation was to evaluate the healing following guided tissue regeneration of bone defects distal to the mandibular second molars after surgical extraction of soft tissue-impacted, mesioangularly inclined third molars. After the impacted third molars were extracted, 15 sites were treated with polyglycolic acid/polylactic acid bioresorbable membranes plus scaling and root planing (SRP) of the distal surface of the second molars (test sites); 15 sites were treated with SRP alone (control sites) according to a split-mouth design. At 12 months after surgery, the placement of barrier material was shown to have resulted in statistically significant differences in clinical attachment level and bone gain compared to control sites.

Today's dental patients are demanding a youthful, attractive smile. The esthetic rehabilitation of patients with functionally compromised dentitions frequently involves a multidisciplinary approach. The realization of esthetic objectives in multidisciplinary cases represents a considerable clinical challenge. To a great extent, proper case selection and careful multidisciplinary treatment planning can govern the predictability of procedures. A team approach that includes the clinicians, the laboratory technician, and the patient is essential to achieve the desired results. This clinical report demonstrates a successful multidisciplinary approach to recreating an esthetic smile of a patient whose anterior maxillary dentition had been functionally and esthetically compromised by prosthetic and periodontal problems.

Impaction of a maxillary canine is common. Orthodontic realignment is not always the therapy of choice. Instead, the impacted tooth can be extracted and replaced by an implant. The replacement of a single tooth with an implant in the anterior maxilla is a topic of interest for clinicians because of its esthetic implications, mostly when immediate loading has been planned. This article describes a clinical case in which an impacted maxillary canine was replaced by an immediately restored osseointegrated implant. A 21-year-old woman with a palatally impacted maxillary canine and the corresponding primary tooth still remaining in the arch was treated. Both the primary and permanent teeth were surgically extracted. A conical-shaped blasted implant was immediately placed into the socket of the primary canine. A self-contained osseous defect remained on the palatal aspect and was filled with bovine bone mineral. The implant achieved excellent primary stability, so it was immediately restored with a provisional acrylic resin crown in light centric occlusion. After 6 months, the definitive metal-ceramic crown was placed. The therapy provided an excellent esthetic result, maintaining ideal soft tissue contours and papillary height. No signs of radiolucency were visible at the 1-year evaluation. The case presented supports the use of single implants for the replacement of extracted primary teeth, especially in areas where esthetics is a high priority. Furthermore, because the prosthetic restoration was done immediately, the overall time needed to restore the patient was considerably reduced in comparison with the time required for the conventional approach.

In this controlled clinical trial, initial and long-term treatment outcomes of guided tissue regeneration (GTR) were investigated for a synthetic absorbable membrane (Atrisorb) in intrabony defects. Eighteen defects in 16 patients received GTR with Atrisorb (test), with the membrane applied by an indirect method, and 15 defects in 15 patients were treated with open flap debridement (control). Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), and linear alveolar bone level (ABL) were recorded at baseline and at 1 and 3 years following the treatment procedures and were assessed as the therapeutic outcome parameters. Both groups demonstrated significant PPD reduction and CAL and ABL gain after 1 year. Among these parameters, alterations in PPD and CAL were statistically significantly greater in the test group than the control group 1 year postsurgery. No significant changes were noted in the parameters of the first year between and within the study groups after 3 years. The results suggest that GTR performed with Atrisorb membrane via an indirect application method may provide favorable clinical outcomes for intrabony defects, and these outcomes may be maintained at least as well as open flap debridement over an extended period.