International Journal of Periodontics & Restorative Dentistry, 03/2006

The need for an accurate diagnosis and treatment plan remains essential for predictable treatment outcomes with dental implants. Advances in computerized tomography (CT) technology now enable the execution of a surgical outcome based on presurgical planning. Precise implant placement no longer relies on socalled mental navigation but rather can be computer guided, based on a threedimensional, prosthetically directed plan. Current CT technology enables all implant team members to embrace the concept of collaborative accountability, which can ensure consistent outcomes. Clinicians can fabricate an implantsupported prosthesis presurgically using patients' CT scan data. The purpose of this paper is to discuss the use of scanning appliances to transfer clinically relevant prosthetic outcome information to a CT data set. With SimPlant software, this information can be used to provide a pretreatment outcome analysis, which can be used for fabrication of stereolithographic models and surgical drilling guides used during osteotomy preparation.

A new therapeutic system using purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with a biocompatible, osteoconductive, synthetic scaffold beta-tricalcium phosphate (ß-TCP) has recently been shown in a large-scale, prospective, blinded, randomized clinical trial to safely and effectively treat advanced periodontal osseous defects. A significant gain in clinical attachment level was observed 3 months postsurgery for sites treated with 0.3 mg/mL rhPDGF-BB + ß-TCP versus ß- TCP + buffer (active control), with this trend continuing at 6 months postsurgery. Additionally, sites treated with 0.3 mg/mL rhPDGF-BB + ß-TCP also had significantly greater radiographic linear bone gain and percent defect fill at 6 months postsurgery than sites that received bone substitute with buffer. Representative cases from the clinical trial were followed to assess their ability to maintain the initial effect of treatment observed at 6 months. At 18 or 24 months postsurgery, with the same clinical and radiographic measurement techniques used as were performed at the 6-month time point for the clinical trial, these cases demonstrated maintenance of the clinical attachment level for all but one case, with all cases demonstrating substantial increases in linear bone gain and percent bone fill versus measurements obtained at 6 months postsurgery. Substantial radiographic changes in the appearance of the defect fill were observed for both rhPDGF-BB treatment groups, consisting of increased radiopacity and bone trabeculation, indicative of increased mineralization and maturation of the bone observed 6 months postsurgery.

The authors present a case of prosthetic rehabilitation of the anterior maxilla. A correct esthetic diagnosis and the development of an appropriate treatment plan are key factors in predictable outcomes. Proper performance of different phases of the treatment plan and the use of appropriate materials guarantee esthetic and functional success. In the case presented, an odontophobic patient with a severely compromised dentition received hygiene, endodontic, periodontal, and prosthodontic therapy following a carefully predetermined treatment plan. Osseous resective surgery and careful material selection for restoration of the prosthetic abutments were key factors in the successful results achieved in the case.

This report describes a protocol that uses computerized tomography (CT), computer-aided design/computer-assisted manufacture (CAD/CAM) technology, and the Internet to plan placement of anterior and posterior dental implants and construct a precise surgical template and definitive prosthesis, which is connected at the time of implant placement. This procedure drastically reduces surgical treatment time and the recovery period. Patients with an edentulous arch had a denture with radiopaque markers constructed for CT scans of the appropriate jaw. The CT images, with acquisition slices of 0.5 mm, were transferred into a three-dimensional image-based program for planning and strategic placement of dental implants. After implants were virtually placed on the computer, the surgical treatment plan was sent to a manufacturing facility for construction of a surgical template and the prosthesis. Special surgical guide components were also manufactured for placement of implants in the pterygomaxillary region. The manufactured surgical components, surgical template, and definitive prosthesis were then delivered to the clinical site. Implant placement surgery was performed using the surgical template, without a flap, and the prosthesis was delivered, achieving immediate functional loading. Minor occlusal adjustments were made. The total surgical treatment time required was less than 60 minutes. Postoperative symptoms, such as pain, swelling, and inflammation, were minimal. Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows precise placement of implants. CAD/CAM technology using the three-dimensional images allows for fabrication of the surgical guide and final prosthesis. This is a significant advancement in implant dentistry and prosthodontics.

The primary goal of this paper was to determine the survival rate of immediately loaded (IL) dental implants based on a systematic review of the literature. Secondary goals were to determine the influence of several factors on the implant survival rate, such as the type of reconstruction, implant location, and implant surface characteristics. An electronic search of databases was performed, in addition to a hand search of the most relevant journals. All relevant articles were independently screened according to specific inclusion criteria. The selected papers were reviewed. The literature search yielded 270 applicable articles up to December 2005. Of these, 71 met the inclusion criteria for qualitative data analysis. Eight articles were randomized controlled trials. The overall implant survival rate for the included studies was 96.39%. The database included 10,491 IL implants placed in 2,977 patients, with a maximum follow-up of 13 years. IL is well documented and predictable for the edentulous mandible (overdentures and full-arch prostheses) and for maxillary single crowns. Fewer data were found for maxillary full-arch reconstructions, fixed partial prostheses, and mandibular single crowns. For the latter two types of reconstructions, implants placed in anterior sites generally displayed a higher survival rate versus those placed in posterior sites. Rough surfaces displayed a higher survival rate than machined surfaces in all types of reconstructions. Most failures (97.1%) occurred within the first 12 months of loading. This review showed that it is possible to apply IL with excellent survival rates. Implant micromorphology and careful patient selection may affect treatment outcomes.

This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. The described technique is a variation of the modified apically repositioned flap (MARF) technique previously proposed. The MARF technique uses one single horizontal incision within keratinized tissue, elevation of a split-thickness flap, and suturing of the flap to the periosteum in an apical position. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The full perimeter of the exposed periosteal area is completely surrounded by keratinized tissue. Therefore, keratinized epithelial cells migrate over the periosteum during wound healing, resulting in the formation of keratinized attached tissue in the area of the previously exposed periosteum. The advantages associated with this surgical technique include its simplicity: It employs one single horizontal incision, generates minimal morbidity since it does not involve any palatal donor tissue, and provides predictable gingival color match.

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Falls and collisions are the most commonly reported causes of dental injuries. These accidents involve principally the maxillary central incisors, causing uncomplicated crown fracture. Many materials and techniques can be used to restore injured anterior teeth. Adhesive dentistry allows reproduction of the original beauty of the teeth and preservation of almost all dental tissues. The aim of this paper is to propose the use of adhesive composite partial crowns as a conservative approach for restoring injured teeth.

The use of autogenous gingival grafts has proved to be an effective and predictable way to increase the amount of keratinized gingiva. However, discomfort and pain at the donor site are unavoidable. Acellular dermal matrix (ADM) allograft can be used as a donor tissue to eliminate the need for another surgical site and alleviate pain and trauma. The purpose of this study was to evaluate the effectiveness of ADM allograft in increasing the width of keratinized gingiva around dental implants. A patient with inadequate keratinized gingiva around dental implants in maxillary and mandibular anterior regions received either an ADM graft or palatal autograft by random allocation. The width of keratinized gingiva and other clinical periodontal parameters were recorded initially and at 3 and 6 months after surgery. Both grafts provided satisfactory results. The width of keratinized tissues was increased by using the ADM allograft, but by a lesser amount than seen with the autogenous gingival graft.