International Journal of Periodontics & Restorative Dentistry, Supplement/2014

Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. Several studies have documented the biologic and esthetic benefits of bone graft containment with either a custom healing abutment or provisional restoration. Use of a prefabricated shell that replicates the extracted tooth at the cervical region can help achieve guided tissue preservation and sustainable esthetic outcomes in an easy, simple, consistent, and less timeconsuming way. The following case report of a hopeless maxillary right central incisor in a female patient possessing adjacent teeth with a thin periodontal phenotype illustrates this new treatment device, method, and concept.

The complexity and labor-intensive nature of making implant-level impressions may inhibit some clinicians from recommending dental implant treatment. This paper describes a simplified impression technique for fabricating anatomical, cement-retained abutments without removing or inserting implant components. Using digitally coded healing abutments, this protocol bridges the gap between traditional impressions and computer-aided abutment manufacturing. Basic logistic considerations are reviewed, as well as other biomechanic and esthetic advantages, that should optimize overall treatment outcomes.

Histologic findings in animal models suggest that the application of dental pulp stem cells (DPSCs) may promote periodontal regeneration in infrabony defects. This case report describes the clinical and radiographic regenerative potential of autologous DPSCs in the treatment of human noncontained intraosseous defects. A chronic periodontitis patient with one vital third molar requiring extraction was surgically treated. The third molar was extracted and used as an autologous DPSCs source to regenerate the infrabony defect on the mandibular right second premolar. At the 1-year examination, the defect was completely filled with bonelike tissue as confirmed through the reentry procedure.

A number of human comparison studies and case series have demonstrated the effectiveness of using a platform-switched implant-to-abutment connection to prevent peri-implant bone loss and subsequent soft tissue loss. To compare the bone around platform-switched and nonplatform-switched connections, adjacent pairs of both connection types were placed in a one-stage surgical procedure on each side of the mandibles of three monkeys (Macaca fascicularis). Eight weeks after abutment connection, histomorphometric analysis showed that both vertical and horizontal alveolar bone resorption had occurred around the nonplatform-switched implants, whereas bone was maintained vertically and new bone formed horizontally around the platform-switched implants.

This prospective study evaluated the survival rate of immediately loaded anatomically tapered implants with a dual acid-etched, microtextured surface. Patients in a private practice were recruited for placement of 3i T3 tapered implants in single, multiple, and full-arch applications in the mandible and maxilla, in both fresh extraction and healed placement sites. Ninety patients were treated, and 240 implants were placed and immediately loaded: 124 in the maxilla and 116 in the mandible. One hundred twelve definitive prostheses were delivered between 4 and 6 months after implant placement. Over the course of 2 to 12 months of follow-up (mean: 4.8 months), five implants failed in the maxilla and no implants failed in the mandible, a survival rate of 96% for the maxilla and 100% for the mandible. The cumulative survival rate was 98%.

Conventional dentoalveolar osseous augmentation procedures for creating bone volume for dental implant placement often involve the use of grafting materials with or without barrier membranes to foster selective cell and tissue repopulation. A study was conducted to determine the efficacy of equine particulate bone (Equimatrix, Osteohealth) to augment the creation of new bone and preserve the volume of bone at extraction sites for the purpose of placing an implant in an optimal position for restoration. Clinical and histologic evidence supported the suitability of equine particulate bone for extraction site augmentation that allowed dental implant placement after a 6-month healing period.

Computer-aided design/computer-assisted manufacture (CAD/CAM) guides for surgery are becoming a widespread tool in implant dentistry. This study sought to evaluate the accuracy and precision of a new guided surgery system. Twenty-five patients were treated in eight centers, and a total of 117 implants were placed using CAD/CAM surgical guides supported by bone, mucosa, and/or teeth. A postoperative computed tomographic (CT) scan of each patient was taken and superimposed on a preoperative CT scan to evaluate any discrepancies between the planned and actual implant positions (apex and platform positions), as well as the implant tilt. Implant placement using bone- and mucosa-supported guides was found to be more precise compared to using guides supported by teeth or a combination of teeth and mucosa. However, the differences were not statistically significant. The accuracy of the guided surgery system is in line with the data found in the literature. Considering the mean positioning discrepancies between the planned and actual implant outcomes, clinicians are advised to maintain a safe distance between implants and anatomical structures of at least 2 mm. In immediate loading cases, relining a provisional prosthesis to compensate for any discrepancies between the virtual and clinical implant positions is recommended.

This case report examined crestal bone level maintenance surrounding a platform-switched implant that was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated tight contact with the surrounding bone and demonstrated both radiographic and histologic features that were indicative of successful osseointegration. Very high boneto- implant contact (BIC) without epithelial downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and native bone. The buccal and lingual bone levels coincided with the original platform position noted at the time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the maintenance of the crestal bone level for platform-switched implants.

In this controlled prospective study, 53 patients treated at four study centers were randomly assigned to receive either (test) implants with platform switching built into their design or similar nonplatform-switched controls (same manufacturer, surface treatment, etc) for treatment of single and multiple edentulous sites in all four quadrants. Radiographs taken at the time of implant placement, definitive restoration delivery, and 1-year follow-up found significantly less crestal bone loss around the test implants (0.25 mm) compared to the controls (0.65 mm). Notably, bone loss around the control inplants had declined by the 1-year follow-up point.

The objectives of this study were to record the prevalence and degree of absence of the maxillary midline interdental papilla and the proportion of patients displaying the maxillary midline papilla during maximum smile among a Caucasian population. Papillary recession was found in 46.4% of study participants (n = 211), while the prevalence of visible recession among maxillary midline papilla during maximum smile was 38.4%, which was statistically significantly less than that of patients diagnosed intraorally with loss of papillary height (P .001). Correlations between age and level of lip line as well as age and visible papillary recession were identified for individuals over 65 years of age. The high prevalence of midline papillary recession in the maxilla found in this population suggests that loss of papillary height constitutes a substantial clinical challenge.

Narrow-diameter implants for overdenture applications have gained in popularity due to their ability to be placed with simplified and less traumatic surgical protocols in limited-width alveolar ridges. The decision of whether to use a flapped or flapless procedure must be guided by a thorough evaluation and evidence-based diagnosis. This article reviews current principles relating to the use of narrow-diameter implants, along with the advantages and disadvantages of current surgical protocols. The indications for the use of each surgical procedure are demonstrated by case reports that highlight diagnosis, surgical planning, and final treatment outcomes.

Multiple adjacent recession defects were treated in 32 patients using a coronally advanced flap (CAF) with or without a collagen matrix (CM). The percentage of root coverage was 81.49% ± 23.45% (58% complete root coverage) for CAF sites (control) and 93.25% ± 10.01% root coverage (72% complete root coverage) for CM plus CAF sites (test). The results achieved in the test group were significantly greater than in the control group, indicating that CM plus CAF is a suitable option for the treatment of multiple adjacent gingival recessions.