Bolz, Wolfgang

The aim of this article is to introduce and illustrate the "Teflon tape technique," which provides good lucidity in combination with excellent isolation of the working field. It is intended to serve as a supplement to the gold standard rubber dam for the adhesive working dental practitioner. Primarily, the Teflon tape technique (Teflon is a registered trademark, and not affiliated with Teflon tape) is particularly suitable for the adhesive cementation of restorations with very thin margins. It allows free access to subgingival areas with variable gingival retraction. Furthermore, this principle can also be applied to other indications, such as Class V restorations or deep core buildups. The technique described is therefore flexible and easy to use. This combination allows a fast integration of the Teflon tape technique into the daily workflow of the dental practitioner. Schlagwörter: adhesive dentistry, dental technology, isolation, prosthodontics, restorative dentistry, veneers

Purpose: Treatment by means of implant-supported immediately loaded fixed full-arch prostheses is known to be related to biologic and technical complications. The aim of this retrospective study was to investigate the prevalence and moment of occurrence of biologic and technical complications happening in immediately loaded fixed full-arch prostheses. Materials and Methods: This study investigated patients who received treatment with immediately loaded fixed full-arch prostheses using four to six implants from 2007 to 2013. The investigation included biologic and technical complications. Complications were depicted regarding their prevalence and their first time of occurrence. Statistical analysis was performed regarding the differences of the mean complication values between the mandible and the maxilla and between technical and biologic complications. Results: The investigation included 482 immediately loaded fixed full-arch prostheses (380 patients, mean observation period: 23.5 months). In 193 arches (40%), either technical (30.9%), biologic (6.5%), or both (3.1%) types of complications occurred. Technical complications occurred significantly more often than biologic complications (P .000). The most frequent technical complication was "fracture of veneering material" (24.7%, arch level). The most frequent biologic complication was "marginal bone loss ≥ 2 mm" (16.3%, implant level). The median first advents of technical complications were after 23/26 months (implant-/prosthesisrelated) and after 3 months for biologic complications, respectively. There was no significant difference of the mean complication rates between the maxilla and the mandible (P = .409). In 99.0% of the arches with complications, the restorations could be obtained. Conclusion: Within this treatment concept, biologic and technical complications may occur over time. However, the vast majority of complications (99.0%) do not affect the overall prosthesis survival. Technical complications are assumed to occur significantly more often than biologic complications. It is suggested that not only stress and material fatigue but also function is a matter concerning this treatment option and, thus, may be a factor related to complication rates. Schlagwörter: immediate function, immediate implants, immediate loading, immediate placement, implant

Die evolutionäre Entwicklung der zahnmedizinischen Behandlung sowie der Materialien und Methoden erlaubt es, unsere Patienten schnell, minimalinvasiv und mit vorhersagbaren Ergebnissen zu versorgen. Etablierte Therapiekonzepte wie die Bone-Lamina-Technik und die Augmentation von subepithelialem Bindegewebe ermöglichen einen neuen Behandlungsansatz. In dem Beitrag wird die Multi-Layer-Technik zur Versorgung von Einzelzahnlücken in der ästhetischen Zone mit Sofortimplantaten in nur einem Eingriff vorgestellt. Bei ersten derart behandelten Patienten konnten stabile Resultate erzielt werden. Daten aus Langzeitstudien sind noch abzuwarten, um den klinischen Erfolg bestätigen zu können. Schlagwörter: Multi-Layer-Technik, Bone-Lamina-Technik, Augmentation, Sofortimplantation, Ästhetik, Einzelzahnversorgung

Die Behandlung von Patienten mit zahnlosen und stark atrophierten Kieferkämmen stellt eine anspruchsvolle Herausforderung für die zahnärztliche Praxis dar. Die Versorgung mit Implantaten ist häufig durch kompromittierte und volumenreduzierte knöcherne Verhältnisse erschwert. Durch die Verwendung von 2 axial gesetzten Implantaten in der frontalen und 2 anguliert gesetzten Implantaten in der distalen Region kann das vorhandene Knochenangebot der Prämaxilla im Oberkiefer und interforaminär im Unterkiefer optimal genutzt werden. In dieser Fallkohortenstudie resultiert die Sofortversorgung von 4 primärstabilen Implantaten mit einer festsitzenden Brücke, ausgehend von den Daten bis zu 5 Jahren und 130 Patienten (161 Kiefer, 644 inserierte Implantate), in einer implantären Überlebensrate von 95,4 %. Es zeigten sich weder signifikante Unterschiede zwischen Implantaten, die im Ober- oder Unterkiefer (p = 0,081) inseriert wurden, noch zwischen axial und schräg gesetzten Implantaten (p = 0,202). Das All-on-four-Konzept mit einem Sofortbelastungsprotokoll bietet eine Versorgung, die sicher vorhersagbare Ergebnisse liefert und in nur einem Eingriff erfolgen kann. Schlagwörter: All-on-four, Implantation, Sofortbelastung, Sofortversorgung

Die Einzelzahnversorgung in der ästhetischen Zone der Oberkieferfront mit einem Sofortimplantat erfordert die Kombination etablierter chirurgischer Techniken. Dazu gehören die Weichgewebeaugmentation mit einem subepithelialen Bindegewebe, welches aus der Tuberregion entnommen wird und die Hartgewebeaugmentation mit der Bone-Lamina-Technik. Die Multi-Layer-Technik ermöglicht eine minimalinvasive Versorgung der Einzahnlücke in nur einem Eingriff mit einem Sofortimplantat. Erste Fälle zeigen stabile Ergebnisse. Daten aus Langzeitstudien sind noch abzuwarten, um den klinischen Erfolg bestätigen zu können. Schlagwörter: Multi-Layer-Technik, Bone-Lamina-Technik, Augmentation, Implantation, GBR, GTR, Sofortimplantation, Ästhetik, Einzelzahn

Purpose: The zygomatic implant is mainly indicated for the rehabilitation of extremely atrophied maxillae when bone augmentation should be avoided. One drawback of zygomatic implants, which typically pass through the sinus, is initial or late bone resorption around the implant neck, which can result in oroantral communications followed by possible infection of the sinus. To decrease the risk of sinus infection, a modified technique was developed to preserve the integrity of the sinus membrane and to regenerate bone around zygomatic implants using an extended sinus grafting approach. Materials and Methods: Patients with extremely atrophied maxillae were provided with one to four zygomatic implants in conjunction with sinus grafting, plus conventional auxiliary implants, for immediate support of a provisional full-arch maxillary prosthesis. Definitive prostheses were delivered at 6 months after implant placement. All patients underwent clinical and radiographic examinations at 6 months. Results: Twenty-two zygomatic and 23 conventional auxiliary implants were placed in 10 patients. The overall 6-month implant survival rate was 90.9% for zygomatic implants and 100% for auxiliary implants placed in the anterior area. Only two minor technical complications were seen, and clinical indicators (including probing pocket depth, keratinized tissue, and plaque and bleeding indices) were good in all patients. A substantial gain of radiographic bone around the zygomatic implants was observed. Conclusion: The proposed technique led to successful prosthetic function for all patients. With the described technique, exposed implant threads within the maxillary antrum are eliminated and the potential for biologic complications is minimized.

The goal of this case series is to present a novel treatment approach for lateral ridge augmentation. Four systemically healthy patients (aged 48 to 59 years) with inadequate dental alveolar ridge widths were selected for inclusion. All ridge defects were augmented using a xenogeneic cortical bone shield in combination with particulated bone substitutes and a thin collagen barrier. At baseline and after 6 months, digital cone beam computed tomography scans were performed. Biopsy specimens were harvested at reentry surgery and processed for histologic analysis. The results revealed a sufficient amount of bone structure for implant placement without additional augmentation procedures. The histologic analysis demonstrated that new bone formation had taken place and the bone shield had resorbed entirely. This case series indicates that the bone lamina technique has the biologic and mechanical properties to succesfully achieve hard tissue augmentation of deficient ridges.

Die gesteuerte Knochenregeneration stellt das Standardverfahren in der Augmentation unterschiedlich ausgeprägter Alveolarkammdefekte dar. Sowohl nicht-resorbierbare als auch resorbierbare Membranen weisen Vor- und Nachteil auf, dazu zählen einerseits die Gefahr der Exposition und andererseits die schnelle Resorption des Materials. Ein entscheidender Faktor scheint jedoch die stabile Raumerhaltung für die knöcherne Regeneration zu sein. Ein neuer Ansatz zur lateralen, knöchernen Augmentation könnte eine resorbierbare knöcherne Membran mit ausreichender Resorptionszeit sein. Diese Technik wird im folgenden Fallbericht dargestellt. Schlagwörter: Laterale Augmentation, gesteuerte Knochenregeneration, Barrieremembranen

Purpose: The purpose of this prospective clinical trial was to evaluate over a 5-year period the treatment outcomes for immediately loaded full-arch fixed prostheses supported by two axially inclined and two tilted implants used to rehabilitate edentulous arches. This report presents preliminary 1-year results. Materials and Methods: Thirty-seven patients were recruited for treatment with either mandibular or maxillary full-arch fixed prostheses supported by four implants. Within 24 hours, the implants were immediately loaded with screw-retained full-arch acrylic resin provisional restorations. Definitive reconstructions were delivered 6 months later. Complete full-arch prostheses were supported by metal frameworks combined with high-density acrylic resin. Follow-up visits were scheduled for 6 and 12 months after initial prosthetic loading and then annually for up to 5 years. Digital radiographs were obtained immediately, 6 months after surgery, and at each annual follow-up visit. Marginal peri-implant bone levels were assessed using digital image analysis. Results: The 1-year implant survival rates were 96.0% for axially positioned implants and 94.6% for tilted implants. The survival rates were 96.6% for maxillary implants and 98.7% for mandibular implants. The prosthetic survival rate was 100%. No significant differences were found in the results for tilted versus axially positioned implants. One year after loading, the mean marginal bone loss was 0.82 ± 0.31 mm around the axially oriented implants and 0.76 ± 0.49 mm around the tilted implants (P = .05). Conclusions: Preliminary data from this clinical trial show high implant survival rates for immediately loaded full-arch prostheses supported by four implants. Immediate loading of tilted implants may be considered a viable treatment option for the rehabilitation of edentulous patients. Schlagwörter: dental implants, edentulous jaw, immediate loading, tilted implants

Tooth extraction will be followed by marked alterations to the tissue volume, in particular in the anterior zone, which may jeopardize the esthetic outcome of any dental treatment involving tooth extraction. If, however, ridge collapse can be prevented or minimized after tooth extraction, more predictable outcomes with superior esthetics can be accomplished along with fewer surgical procedures. Therefore, it was proposed that stabilizing the soft tissue architecture with a free gingival graft could minimize the soft tissue shrinkage. The following case report describes some surgical modifications and refinements in order to enhance the predictability of the socket- seal surgery.