Immediate implant and socket preservation using sticky bone and leukocyte-platelet-rich fibrin in the anterior maxilla: A 3-year case report.

INTRODUCTION: Immediate implant in the esthetic area is a challenging procedure. Chronic infection often contributes to extensive bone loss and acute infection often precludes a safe, clean surgery. However, it is quite common to come across failing teeth in the esthetic area, where the patient often demands a faster rehabilitation. CASE PRESENTATION: In this clinical case, a fractured upper central incisor was replaced by an immediate implant, and the perimetrical area was filled with heterologous bone blended with patient-derived leukocyte- and platelet-rich fibrin (L-PRF) in the form of sticky bone. A Maryland bridge was bonded to the adjacent teeth with the intent to guarantee minimum esthetic to the patient. After 5 months, the implant was connected to a definitive abutment and crown. The facial and interdental soft tissue was maintained with appreciable success after 2 years. The pre-treatment and 2-year- post-treatment computed tomography scans revealed marginal bone preservation. CONCLUSION: The use of sticky bone and L-PRF in immediate implant sites helps prevent hard and soft-tissue collapse and may favor faster and sounder healing. KEY POINTS: Why is this case new information? It provides support to the efficacy of immediate implant placement with simultaneous use of L-PRF. What are the keys to successful management of this case? Having L-PRF supporting wound healing. What are the primary limitations to success in this case? Having sufficient bone apical to the existing socket and at adjacent teeth.

Immediate restoration of fixed full-arch prostheses placed on implants in both fresh and healed sockets using the flat one-bridge technique: a 7-year retrospective study.

BACKGROUND: The aim of this retrospective study was to document the long-term clinical efficacy of a surgical-prosthetic technique (the flat one-bridge technique) involving the immediate restoration of both postextraction and nonpostextraction implants supporting full-arch restorations. METHODS: Implants were placed by adapting the axis to the available bone. Flat definitive abutments were connected during surgery and never disconnected to compensate for eventual implant disparallelism. Bone grafting was performed when needed. The patients received a screw-retained provisional restoration within 48 h of surgery and a final screw-retained prosthesis within 1 year. RESULTS: Sixty-six patients received 494 implants distributed in 75 prostheses. The median follow-up was 86 months (range 82-168 months). Only three implants had failed at the last follow-up. Implant survival was 99.6%. CONCLUSION: The flat one-bridge prosthetic protocol is a viable procedure with excellent long-term outcomes. No difference in clinical success could be observed between postextractive and nonpostextractive implants.

Fully Guided Zygomatic Implant Surgery.

INTRODUCTION: Rehabilitating a severely atrophic maxilla is a complex procedure. In case of severe resorption, zygomatic implants are indicated and loading of the implants at the end of the surgery is desirable. We present a new method by means of guided surgery for the placement of zygomatic implants, using specially designed metal templates that should be supported by bone. METHODS: The treatment planning for completely guided prosthetic rehabilitation of the maxilla with zygomatic implants was digitally performed. A radiographic template was designed for the prosthetic treatment planning. A surgical template was used to replicate the digitally planned steps in vivo. RESULTS: The procedure ended with the positioning of a custom-made temporary prosthesis. This method can reduce the surgery duration, simplify the procedure, and optimize the outcome. It requires equal cooperation among technicians, prosthodontists, and surgeons. Nineteen out of twenty patients included in the study presented successful implants and prosthesis at the moment of analysis. CONCLUSIONS: The present approach addressed the needs for zygomatic-implant surgery. The surgical and prosthetic plan, position, emergence, the shape of the implants, the position of the temporary prosthesis, the inter-arch relationships, and surgical templates were designed in a completely virtual environment and performed by the surgeon on stereolithographic models beforehand. Consequently, the surgical procedure was considerably simplified.

The use of bone block allografts in sinus augmentation, followed by delayed implant placement: A case series.

PURPOSE: This article reports the clinical outcomes observed in a large number of patients receiving block bone allograft used for sinus augmentation and delayed implant placement. PATIENTS AND METHODS: In total, 28 patients (13 males) with a mean age of 49.8 ± 10.1 years (range: 33-67 years) were included in this case series. All selected patients suffered from severe alveolar ridge atrophy in the posterior maxilla and required bone augmentation procedures, followed by implant placement after 6 months. All patients were followed for 18 months after the grafting, with scheduled monthly visits and/or more frequent visits if required. The survival rates for both the bone blocks and placed implants were then evaluated. RESULTS: A total of 42 blocks and 90 implants were placed. Only one bone graft and 5 implants failed; the survival rate was 97.2% and 95.5% for the bone grafts and implants, respectively. The graft failed due to the onset of post-surgical infectious sinusitis, while in some patients' implants showed absence of osteointegration at the end of the healing phase. Of note, all failed implants were observed in heavy smokers; in all other patients, blocks and implants were successful. CONCLUSIONS: This preliminary case series suggests that the grafting of bone allograft followed by delayed implant placement may be a promising strategy for sinus augmentation. More extended and larger follow-up studies are needed to confirm this preliminary data.