Unconventional implant placement. V: Implant placement through impacted teeth; results from 10 cases with an 8- to 1-year follow-up.

The aim of this paper is to document additional cases to an unconventional protocol published in 2009. In 9 patients, sites rendered edentulous by the presence of an impacted maxillary canine were treated with 12 implants placed through the impacted canines. In another patient, 3 implants were inserted in the mandible to rehabilitate a failing bridge. Implants were placed encroaching upon either the root or the crown. No postoperative pain was reported. Healing was uneventful in all but one patient; the latter underwent soft tissue infection 2 weeks after implant placement and was successfully treated. All implants were restored; no implant failed during the 1- to 8-year follow-up. Before implementing this protocol on a routine basis, more implants and a longer follow-up are required. However, it opens intriguing treatment possibilities. It also suggests that there is still room for shifting a well-anchored paradigm in dental implantology.

Unconventional Implant Placement Part III: Implant Placement Encroaching upon Residual Roots - A Report of Six Cases.

BACKGROUND: When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. PURPOSE: We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. MATERIALS AND METHODS: Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. RESULTS: Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. CONCLUSION: Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.

Technique to Obtain a Predictable Aesthetic Result through Appropriate Placement of the Prosthesis/Soft Tissue Junction in the Edentulous Patient with a Gingival Smile.

BACKGROUND: Treating the edentulous patient with a gingival smile requires securing the prosthesis/soft tissue junction (PSTJ) under the upper lip. PURPOSE: To present a simple method that helps achieve a predictable aesthetic result when alveoplasty of the anterior maxilla is needed to place implants apical to the presurgical position of the alveolar ridge. MATERIALS AND METHODS: The maximum smile line of the patient is recorded and carved on a thin silicone bite impression as a soft tissue landmark. During the three-dimensional radiographic examination, the patient wears the silicone guide loaded with radiopaque markers. The NobelClinician® software is then used to bring the hard and soft tissue landmarks together in a single reading. Using the software, a line is drawn 5 mm apical to the smile line; it dictates the position of the crestal ridge to be reached following the alveoplasty. Subsequently, the simulated implant position and the simulated residual bone height following alveoplasty can be simultaneously evaluated on each transverse section. RESULTS: An alveoplasty of the anterior maxilla was performed as simulated on the software, and implants were placed accordingly. The PSTJ was always under the upper lip, even during maximum smile events. The aesthetic result was, therefore, fully satisfactory. CONCLUSION: This simple method permits the placement of the PSTJ under the upper lip with a predictable outcome; it ensures a reliable aesthetic result for the edentulous patient with a gingival smile.

[Implants in contact with tissues other than bone. Is there room for a potential paradigm shift?]. / Implants au contact de tissus autres qu' osseux.

RATIONALE: Modern dental implantology is now 30 year old. During this period of time, concepts have evolved and triggered several paradigm shifts. The aim of the present paper is to present a case treated with an innovative unconventional protocol. The latter is aimed to avoid invasive surgery when edentulism is caused by an impacted tooth. OBJECTIVES: The implant has been placed through the impacted canine and led, in addition to the classical implant-bone interface, to several other types of implant-tissue interface. RESULTS: Healing was uneventful; at the 1-year control, the implant was clinically integrated, the soft tissues around the final crown were satisfactory and the radiographic examination did not call any specific observation. CONCLUSIONS: Before endorsing this protocol in routine application, inclusion/exclusion criteria must be asserted and additional clinical cases with longer follow-up are warranted. Nonetheless, this unconventional protocol opens intriguing possibilities; it also suggests that there is still room to further revisit some of the leading concepts in dental implantology.