International Journal of Periodontics & Restorative Dentistry, 06/1992

The surgical protocol for inferior alveolar nerve transposition together with the Brånemark implant treatment is described. The short-term follow-up results of the first ten procedures are presented and show an initial 2- to 3-week duration of anesthesia. In all regions treated, signs of paresthesia/hypoesthesia have been registered for 1 to 7 months. After 6 months, seven of the regions recovered completely with regard to nerve sensation.

Two case reports are presented to demonstrate a treatment that restores proper esthetics, cures hypersensitivity, and enhances periodontal support for cases of root caries or failing Class V restorations associated with gingival recessions. The procedure involves removing the existing restoration, elevating a trapezium-shaped full thickness flap, root planing to achieve a desired concave shape, and placing a barrier membrane. In both cases, satisfying clinical results have been maintained for 18 months.

Five patients with sufficient vertical bone height but insufficient bone width for implant placement were chosen for treatment with a split-crest technique combined with guided tissue regeneration. The surgical technique involved splitting the alveolar ridge longitudinally in two parts, provoking a greenstick fracture. A chisel was then used to make a fine cut and spread apart the two cortical plates. Implants were then placed. Implants and defects were covered with expanded polytetrafluoroethylene membranes. Biometrical examination showed a gain in bone width, varying between 1 and 4 mm; maxillary sites showed greater ridge enlargement. Histologic examination showed regeneration of bone tissue between the two portions of the split crest. This membrane technique could be effective and predictable for horizontal ridge augmentation associated with immediate implant placement.

Four intrabony lesions from four patients were studied. Presurgical measurements included clinical attachment level, degree of recession, probing pocket depth, Plaque Index, Gingival Index, and Sulcular Bleeding Index. These measurements were also taken at 6-month intervals after surgery. Surgery involved exposing the intrabony defects by a papillary preservation technique, planing, and placing blocks of coralline hydroxyapatite. Three biopsy specimens and one block section were removed from the treated lesions at various periods ranging from 6 to 36 months. Clinical and histologic observation provided evidence of osteogenesis around and through the coralline hydroxyapatite.

A statistical study of the Steri-Oss implant system, concerning 673 implants placed in 280 patients in the course of a 5-year period, allows a therapeutic proposal to be made that will optimize the success rate of osseointegration. The study revealed indications specific to each type of implant, according to the depth and density of available bone. The use of titanium screws is recommended whenever bone quality is type I. In all other cases, where the density of bone decreases and approaches type IV, especially in the posterior maxilla, cylindrical hydroxyapatite-coated implants are recommended.

There are several advantages to the CeraOne single-tooth abutment. It seats directly onto the fixture, forming a nonrotating joint. A new type of gold alloy screw that can be tightened to 32 N/cm is used. In addition, the restoration is constructed on a prefabricated ceramic cap onto which porcelain is directly baked. A case report illustrates the technique and the highly esthetic results of such single-tooth replacement.