Libros

The aim of this classification is to diagnose and grade four different types of soft tissue deficiency around loaded, osseointegrated implants according to increasing severity. The suggested soft tissue augmentation to increase the width of the peri-implant keratinized mucosa will improve the long-term stability of peri-implant tissues.

The aim of this retrospective study was to evaluate long-term clinical and radiologic outcomes of submerged and nonsubmerged guided bone regenerative treatments for peri-implantitis lesions. Strict methods of implant-surface decontamination and detoxification were performed. Data on clinical probing depth, soft tissue measures, and marginal bone level that were documented by comparative radiographs were obtained from 45 patients, for a total of 57 implants prior to treatment and at the latest follow-up. The average followup period was 6.9 years (range: 2 to 21 years). Analysis of implant-based data revealed a success rate of 70.2% for a total of 40 implants. Recurrence of periimplantitis was observed on 9 implants, and 8 implants were removed. The regenerative procedures, under a strict periodontal control, were effective in the treatment of moderate to advanced peri-implantitis lesions.

Dental agenesis is the most commonly encountered dental anomaly in humans. Oligodontia, however, is a rare condition that involves the congenital absence of six or more teeth, excluding the third molars. Treatment of oligodontia requires an interdisciplinary approach. The prosthetic treatment plan should carefully consider esthetic and functional rehabilitation but should take a conservative approach. Adhesive techniques, combined with the new ceramic materials, permit functional and esthetic prosthetic restorations that are more conservative in comparison to those used in the past. Ultrathin occlusal veneers without tooth preparations may represent a good esthetic and conservative approach for oral rehabilitation of patients affected by severe hypodontia.

This case series presents clinical outcomes on reentry using regenerative submerged and nonsubmerged approaches in peri-implant defects; pre- and posttreatment assessments of nine implants in six patients are presented. A mean bone fill value of 91.3% with a 4.88-mm mean bone gain was obtained. Neither approach led to additional bone loss or required additional bone augmentation procedures. Strict methods of implant surface decontamination and detoxification were used on all patients, regardless of implant surface characteristics. The regenerative procedure was effective in the treatment of moderate to advanced peri-implantitis lesions without compromising the previous fixed implant-supported prostheses. These preliminary results are reasonably encouraging in that all cases showed bone gains. Nevertheless, caution must be exercised when determining reosseointegration, because it is not possible to ascertain it in clinical practice.

This case series presents the use of a resorbable "dome device" made of a slow, long-lasting resorbable suturing material to support the barrier creating and maintaining a secluded space to promote bone regeneration. Acellular dermal matrix or cross-linked resorbable collagen membrane, as barriers, combined with mineralized freeze-dried bone allograft, with simultaneous implant placement, were utilized in reconstructing non-space-making defects. Eight implants in six healthy patients were treated with a combination of these resorbable regenerative materials. Only one of seven was treated with a nonsubmerged approach. All sites remained completely covered and no implant exposure occurred during healing. At the 9- to 24-month reentry surgeries, the clinical bone density was equivalent to that of the native bone and the mean number of final exposed threads was 0.5. The mean buccal bone thickness achieved was 3.12 mm, with a mean total coverage of exposed threads in approximately 87.5% of the cases.

A mixture of mineralized allograft cortical and cancellous chips was used to augment the maxillary sinuses of 10 patients. Eleven sinus augmentation procedures were performed, and 19 bone cores were obtained at reentry after 6 to 7 months. Computed tomography at 6 months postaugmentation demonstrated bone formation in all sites. Light microscopic and histomorphometric evaluation confirmed bone formation at the treatment site that would receive osseointegrated implants to replace the missing maxillary posterior teeth. These encouraging results support the use of a mixture of mineralized allograft cortical and cancellous chips for sinus augmentation.

Peri-implantitis is a frequently occurring inflammatory disease mediated by bacterial infection that results in the loss of supporting bone. Peri-implantitis should be treated immediately, but there is a lack of evidence regarding the most effective therapeutic interventions. Nonsurgical periodontics may be the treatment of choice in cases of peri-implant mucositis or if the patient has medical contraindications or refuses to consent to more appropriate treatment. Peri-implantitis defects will dictate the therapeutic approach and present a guideline for relative clinical management. The suggested therapeutic solutions are derived from clinical experience and are meant to be a useful guide.

This article describes a soft tissue surgical modification-the trap door technique-used to enhance contemporary patient esthetic expectations and preserve periodontal health longitudinally. This surgical modification is greatly indicated for single-stage single and multiple implant surgery to preserve the integrity of the papillae and eliminate buccal soft tissue concavity. This procedure also addresses the issue of interproximal papillary development to obviate the presence of a black triangle. The technique is very effective in cases of minimal interproximal bone loss, it does not require autogenous bone harvesting, and is therefore less invasive and well accepted by the patient.

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.

The objective of this investigation was to determine the fate of thin buccal bone encasing the prominent roots of maxillary anterior teeth following extraction. Resorption of the buccal plate compromises the morphology of the localized edentulous ridge and makes it challenging to place an implant in the optimal position for prosthetic restoration. In addition, the use of Bio-Oss as a bone filler to maintain the form of the edentulous ridge was evaluated. Nine patients were selected for the extraction of 36 maxillary anterior teeth. Nineteen extraction sockets received Bio-Oss, and seventeen sockets received no osteogenic material. All sites were completely covered with soft tissue at the conclusion of surgery. Computerized tomographic scans were made immediately following extraction and then at 30 to 90 days after healing so as to assess the fate of the buccal plates and resultant form of the edentulous sites. The results were assessed by an independent radiologist, with a crest width of 6 mm regarded as sufficient to place an implant. Those sockets treated with Bio-Oss demonstrated a loss of less than 20% of the buccal plate in 15 of 19 test sites (79%). In contrast, 12 of 17 control sockets (71%) demonstrated a loss of more than 20% of the buccal plate. In conclusion, the Bio-Oss test sites outperformed the control sites by a significant margin. No investigator was able to predict which site would be successful without the grafting material even though all were experienced clinicians. This leads to the conclusion that a patient has a significant benefit from receiving grafting materials at the time of extraction.