The placement of a dental implant by creating the osteotomy through the remaining root can serve as a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures such as the mental foramen and inferior alveolar nerve in close proximity to the planned osteotomy, and facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area. Keywords: mandible premolar implant, osteotomy through the root, mental foramen

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure—including lateral window sinus augmentation and guided bone regeneration—allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Implant-supported restorations have proven to be a predictable option for replacing missing teeth. In cases of inadequate bone quantity, the bone volume can be increased by bone augmentation procedures. Several factors can affect bone regeneration, including the morphology of the defect at the implant site. A defect surrounded by bony walls (an intraosseous defect) is known to yield a highly successful regeneration. The purpose of this retrospective case series study was to present a new step-by-step surgical procedure known as the Custom Alveolar Ridge-Splitting (CARS) technique for maxillary anterior ridge augmentation. This technique creates an intraosseous defect while splitting and augmenting an atrophic ridge. Sixteen consecutive cases were treated with the CARS procedure. All implants were restored and followed for 12 to 24 months after loading, and all cases were effectively treated with successful implant placement. According to this retrospective study, the CARS procedure is simple, successful, and predictable and may be used as a surgical option for horizontal alveolar ridge augmentation in the anterior maxilla.

The posterior maxilla has traditionally presented a challenge for successful placement of dental implants due to a combination of poor bone quality, ridge atrophy, and pneumatization of the sinus floor following tooth extraction. However, with the successful and predictable surgical outcomes reported in the literature, more clinicians and patients are choosing an implant-supported restoration in the edentulous posterior maxilla. Consequently, sinus elevation and augmentation have gained more popularity. Extensive research has been conducted on types of bone graft materials and implants, less-invasive techniques to perform sinus augmentation, and timing for implant placement for sinus grafting. Despite the predictability of the techniques and biomaterials employed in sinus grafting procedures, intra- and postoperative complications are common. Much of the current literature discusses the local risk factors related to sinus augmentation, with few studies focusing on the patient-related risk factors. The purpose of this review is to identify, evaluate, and discuss the possible management of patient-related risk factors to allow for more predictable maxillary sinus floor augmentation outcomes.

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. SARS CoV-2, the virus that causes COVID-19, has shown the ability to become aerosolized with a potential airborne route of transmission. Dentists and dental hygienists are listed as two of the occupations in a nonhospital setting with the greatest risk of contracting the SARS-CoV-2 virus, as routine dental procedures involve aerosol generation. In a statement on interim guidance, WHO recommended that all routine dental procedures be delayed until COVID-19 transmission rates decrease from community transmission to cluster cases and until the risk of transmission in a dental office can be studied and evaluated. This prospective study involves 2,810 patients treated over a 6-month period (March 15 to September 15, 2020) in three different dental offices by two dentists and three hygienists during and shortly after the height of the pandemic in New York. By utilizing screening questionnaires, performing enhanced infection control, and having appropriate personal protective equipment, these dental offices were able to record no transmission of COVID-19 to the dental healthcare workers or patients during the study. In addition, 69% of the patients treated in these dental offices were recorded as having one or more high-risk comorbidities related to COVID-19 severity.

A link between periodontitis and cardiovascular disease has been reported in the literature. For this systematic review, the keywords "cardiovascular disease" (CVD) were combined with "periodontitis" and "peri-implantitis" and were used to search for literature published on MEDLINE and PubMed between 1990 and 2020. Hand searching was also performed. A total of 206 articles were identified, 51 of which were reviewed. A link between periodontal disease and CVD can be explained by both the infection and inflammatory pathways. Interventional studies on the treatment of periodontal disease related to CVD have shown conflicting results. Therefore, based on published studies, CVD should presently be considered a comorbidity of periodontitis (with an association but no direct cause and effect documented). The association of CVD with peri-implantitis has too few studies to draw any conclusions. More studies are necessary before any conclusions can be made between CVD and periodontitis and CVD and peri-implantitis regarding possible links and the extent of association.

The purpose of this retrospective study was to evaluate bone level stability around 441 mandibular and 350 maxillary molar implants, placed using an immediate implant protocol, that had been in function from 2 to 17 years postrestoration (mean: 9.9 years). Independent radiographic measurements using the known distance between threads on the specific implant that was used indicated a mean bone loss of 0.27 ± 0.68 mm around maxillary implants and 0.27 ± 0.67 mm around mandibular implants. Maxillary implants showed a statistically significant (SS) difference in bone loss on the mesial (0.20 mm) compared to the distal side (0.34 mm). In the mandibular group, there was an SS difference in bone loss around implants with wide (≥ 5 mm) and regular ( 5 mm) diameters. There was also an SS difference in bone loss in patients 50 years and older (0.28 mm) compared to patients younger than 50 (0.18 mm). In both groups, there were no SS differences in bone loss between machined- and rough-surface implants, men and women, single and splinted implants, nonsmokers and light/heavy smokers, or in patients with a penicillin allergy who were prescribed azithromycin as an alternate prophylactic antibiotic. All SS differences found in variables evaluated in the study were 1.0 mm and therefore were considered clinically insignificant.

This report discusses the expanded use of narrow-diameter implants ( 3.0-mm diameter) for permanent use and presents multiple clinical uses for supporting permanent restorations. The increased applications of narrow-diameter implants have expanded the options of treatment available to clinicians based on the patients' needs, desires, and limitations. The advantages, disadvantages, indications, and limitations are presented for the use of these narrow-diameter implants for permanent-case scenarios. These implants can serve as a treatment option in cases where standard-diameter implants cannot be placed due to limitations in volume or size of a planned implant site or due to financially or medically compromised patients.

Peri-implantitis is a biologic complication that can affect the survival of a dental implant. Most surgical and nonsurgical treatments have been relatively ineffective even when using targeted antimicrobial approaches. A growing number of reports are documenting the presence of titanium granules and/or cement in the soft tissues surrounding peri-implantitis–affected dental implants. Two case reports are presented demonstrating how the Nd:YAG or a carbon dioxide (CO2) laser used following regenerative surgeries changed failures into successes as measured by radiographic bone fill and improved clinical parameters. These cases suggest that successful peri-implantitis treatment may need to incorporate decontamination of the soft tissues in addition to the implant's surface. Further studies are warranted to determine if each of these lasers would be successful over a larger patient cohort.

The purpose of this article is to compare the larger (8 × 10-mm single implant and 15 × 20-mm multiple implant) lateral window designs used in the sinus elevation procedure with a newly proposed, less-invasive window design and discuss the advantages and limitations of the new design. The less-invasive window designs differ from the larger window designs in both the size and shape of lateral windows. Following creation of a round-window osteotomy, the quality of the sinus membrane and its ability to be elevated are assessed. The initial window can then be enlarged as a vertical oval window for a single implant or a horizontal oval window for multiple implants. The advantages of these window designs include the preservation of the lateral walls, blood supply to bone grafts, and better containment of the graft material. The limitations of these window designs are decreased visibility, accessibility for correcting a membrane perforation, and access for draining a sinus infection if one occurs. These complications necessitate increasing the size of the window as needed for successful treatment. The proposed less-invasive window design provides distinct advantages for a successful sinus elevation procedure and decreased patient morbidity.