Simultaneous implant placement and restoration with guided bone regeneration in the mandibular anterior region.

BACKGROUND: Restoring the mandibular anterior teeth by implants can be difficult due to potential complications arising from using prosthetic implant connections that are larger than the incisors at the cementoenamel junction level. METHODS: This retrospective study is aimed at determining the survival and esthetic outcomes of anterior mandible implants immediately placed and restored in patients diagnosed with stages 3-4 periodontitis. The study included 75 implants that were inserted along with guided bone regeneration in 42 patients. Over a follow-up period of 3 to 8 years (mean of 6.95 ± 1.78 years), the study evaluated esthetic, marginal bone loss (MBL), and biological and prosthetic complications. RESULTS: No failures were recorded during the follow-up period; after eight years, the survival rate was 100%. Patient's age and gender did not have a statistically significant impact on MBL, but smokers had a greater MBL than non-smokers at the 8-year (2.98 mm vs. 1.23 mm, respectively, p = 0.016) time-point. At 3 years, only 13.3% of the implants had mesial papillae, 36.0% had distal papillae, and 16.0% had the cervical metallic part of the abutment exposed. Peri-implantitis was diagnosed in 20.7% of the patients at the 8-year follow-up time. CONCLUSIONS: Based on the limitations of this study, immediate placement and restoration of the mandibular incisors can be a feasible procedure, but only a few implants achieved the complete restoration of the papillae.

Osseoconduction of an Airborne Particle-Abraded and Etched Titanium Alloy Surface in Type IV Bone: A Human Histologic and Micro-CT Evaluation.

The present study aimed to evaluate the osseoconduction ability of an airborne particle-abraded and etched (SAE) titanium alloy surface when placed in humans with poor bone quality. Four patients scheduled to receive an implant-supported full-arch prosthesis received two additional reduced-diameter implants to be harvested after 6 months of submerged healing. Undecalcified vestibulopalatal/vestibulolingual histologic sections were prepared after the micro-computerized tomography (µCT) examination. Six implant sides from four biopsied implants displayed a type IV bone environment and were included in the present study. Bone-to-implant contact (BIC) was first measured on each implant side. The estimated initial BIC (E-iBIC) was evaluated by superimposing the implant profile 0.25 mm away from its actual position. The µCT provided information about the local and adjacent bony architecture. The mean BIC was 62.5% ± 10.6%, while the mean E-iBIC was 33.1% ± 4.4%. The E-iBIC/BIC ratio was 1.81 ± 0.38. The 3D µCT sections showed the thin bone trabeculae covering the implant surface; although they seemed to be separated from the rest of the bony scaffold, they were much more interconnected than what appeared to be on the 2D histologic preparations. This limited number of human histologic samples document, for the first time, that the SAE titanium alloy implant surface is apparently osseoconductive when placed in poor human bone quality. The average BIC was 1.81 times higher than the E-iBIC. This high osseoconductivity may explain the predictable clinical behavior of implants with this type of SAE textured surface in type IV bone.

Physical characterization of 3 implant systems made of distinct materials with distinct surfaces.

STATEMENT OF PROBLEM: Dental implants undergo various surface treatments. Studies that have characterized their surface and subsurface by using the same methods are scarce. PURPOSE: The purpose of this study is to physically characterize the surface and subsurface of implant systems made of commercially pure (cp) titanium (Ti) grade (gr) 4 and Ti alloy gr 23 and to evaluate whether airborne-particle abrasion and acid etching is an appropriate surface treatment for Ti alloy gr 23. MATERIAL AND METHODS: Implant groups (n=3) were as follows: TG4AO, cp Ti gr 4, treated with anodic oxidation (3.5×8 mm) (NobelReplace Conical; Nobel Biocare); TG23AE, Ti gr 23 (TiAlV ELI) airborne-particle abraded-and-etched (3.9×8 mm) (V3; MIS); and TG4AE, cp Ti gr 4, airborne-particle abraded and etched (3.3×8 mm) (BL; Institut Straumann AG). Surface roughness, surface topography, and elemental and surface composition were investigated with optical profilometry, scanning electron microscopy, energy dispersive X-ray spectroscopy, and X-ray diffraction. The presence and size of Ti hydride (TiH) needles were determined on metallographic sections. Depth profiling was obtained by time-of-flight secondary ion mass spectrometry (ToF-SIMS) to determine possible enrichment of an alloying element at the implant surface. RESULTS: The mean arithmetic deviation roughness (Sa), of TG4AO was 0.80 µm. The Sa of TG4AO was 1.22 µm, and the Sa of TG4AO was 1.59 µm. The difference between the groups was significant (P<.001). TG23AE and TG4AE displayed a macrotexture and microtexture with pores; TG4AO showed a 3-to 12-µm canyon-like structure. The surface and subsurface compositions were as follows: for TG4AO, αTi and phosphorus-rich anatase; for TG23AE, α-Ti matrix with ß-Ti grains; and for TG4AE, α-Ti and δ-TiH2-x. TiH needles were found only on TG4AE; the Ti oxide layer of TG4AO was rough, 3-to 16-µm thick, and porous. The time-of-flight secondary ion mass spectrometry (ToF SIMS) concentration profile of TG23AE did not show enrichment of any alloying element. CONCLUSIONS: The roughness, topography, and composition of the surfaces were different for all implants tested. Airborne-particle abrasion and subsequent etching was an appropriate treatment for Ti gr 23 alloy implants.

Effect of soft tissue thickness on crestal bone loss of early loaded implants with platform switching: 1- and 5-year data.

Objectives: The aim of this retrospective study was to evaluate the effect of vertical soft tissue thickness (STT) on crestal bone loss (CBL) of early loaded implants after 1 and 5 years. Method and materials: Forty-four tapered implants with platform switching and conical connection were placed in the posterior mandible and maxilla to rehabilitate edentulous sites. STT at implant sites was divided into two groups: thin (n = 21, mean STT = 2.0 ±â€¯0.3 mm) and thick (n = 23, mean STT = 3.0 ±â€¯0.8 mm). The implants were loaded after 6 to 8 weeks. Survival and success rates and CBL were measured after 1 and 5 years. Results: The survival and success rates at 1 and 5 years were 100% and 97.8%, respectively. At the 1-year follow-up, the CBL of the thin and thick gingival groups was 0.96 ±â€¯0.49 and 0.55 ±â€¯0.41 mm, respectively; the difference was statistically significant (P = .004). At 5 years, the CBL of the thin and thick gingiva groups increased to 1.12 ±â€¯0.84 and 0.65 ±â€¯0.69 mm, respectively; the difference was not statistically significant (P = .052). Conclusion: At 1 year, the CBL was more pronounced at sites with a thin gingiva; at 5 years the difference between the groups was not statisically significantly different. Within the limitations of this study, early loading of implants with platform switched and conical connection was safe.

Characterization of a Macro- and Micro-Textured Titanium Grade 5 Alloy Surface Obtained by Etching Only without Sandblasting.

Our purpose was to physically characterize the surface, and the subsurface, of a macro- and micro-textured titanium grade 5 dental implant surface obtained by etching only, without sandblasting. The topography, surface roughness, as well as the surface structure and subsurface distribution of elements, were determined by scanning electronic microscopy (SEM), non-contact profilometry, X-ray diffraction (XRD), and a concentration profile performed by Auger electron spectroscopy (AES). The hydrogen concentration in the implants was measured; the ability to generate nanostructures when stored in deionized water was also investigated. Under SEM, the surface resembled a sandblasted and etched titanium surface with its typical macro- and micro-texture; roughness was moderate with average roughness (Sa) 1.29 µm. No titanium hydride was found at the implant surface and no enrichment of any alloying element was identified at the surface and subsurface. Hydrogen concentration was 79 ppm, within the normative tolerance (<130 ppm). After storage in water for 6 months, densely packed finger-like nanostructures were observed. The clinical advantage of this textured titanium alloy surface is that it displays the typical macro- and micro-features of a moderately rough sandblasted and etched (SLA) titanium surface without leaving behind any foreign sandblasting material.

In vitro Interactions between Streptococcus intermedius and Streptococcus salivarius K12 on a Titanium Cylindrical Surface.

Peri-implantitis is a steadily rising disease and is caused by oral bacterial pathogens able to form biofilm on implant surfaces and peri-implant tissues, making antibiotics treatment less effective. The use of commercial probiotics against oral pathogens could serve as an alternative to prevent biofilm formation. Streptococcus intermedius is one of the early colonizers of biofilm formation in dental implants. The aim of this study was to model the interaction between S. intermedius and Streptococcus salivarius strain K12, a probiotic bacterium producing bacteriocins. S. intermedius was co-cultured with S. salivarius K12 in an in vitro model simulating the biofilm formation in a dental implant composed by a titanium cylinder system. Biofilm formation rate was assessed by Real-Time PCR quantification of bacterial count and expression levels of luxS gene, used in response to cell density in the biofilm. Biofilm formation, bacteriocin production, luxS expression patterns were found to be already expressed within the first 12 h. More importantly, S. salivarius K12 was able to counter the biofilm formation in a titanium cylinder under the tested condition. In conclusion, our dental implant model may be useful for exploring probiotic-pathogen interaction to find an alternative to antibiotics for peri-implantitis treatment.

Treatment of medication-related osteonecrosis of the jaws (MRONJ) with ultrasonic piezoelectric bone surgery. A case series of 20 treated sites.

PURPOSE: There is no consensus on how to successfully treat medication-related osteonecrosis of the jaws (MRONJ). We report here on the application of piezoelectric bone surgery to treat MRONJ in combination with antibiotherapy and on its possible benefit. MATERIEL AND METHODS: A cohort of 18 consecutive patients has been treated for MRONJ; they involved 20 sites, 15 in the mandible, and five in the maxilla. Surgical removal of the necrotic areas and debridement was performed with a powerful piezoelectric surgery device (max 90 W) in combination with antibiotherapy. RESULTS: All patients healed and obtained a complete soft tissue closure within 1 month. No recurrence of the symptoms was observed during the present follow-up (10-54 months). CONCLUSION: We hypothesize that healing of all treated sites might have resulted from the synergic effect of bone ablation, biofilm alteration, and antibiotic administration. Biofilm alteration might have permitted a better access of antibiotics to the involved germs. These encouraging results warrant further studies on the use of ultrasonic surgery to treat MRONJ patients in order to confirm or refute the hypothesized effect.

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.

Immediate implants placed in infected and noninfected sites after atraumatic tooth extraction and placement with ultrasonic bone surgery.

BACKGROUND: Only a few reports deal with implants placed in infected postextraction sites. PURPOSE: Survival rates of a cohort of immediate implants cases placed in acute and chronically infected sites were compared with a cohort of noninfected ones while (1) tooth extraction and osteotomy sites were prepared with a piezosurgery device and (2) ultrasonication was applied to abate the bacterial charge at infected sites. MATERIALS AND METHODS: Eighty-six patients received 168 immediate implants distributed into three groups: noninfected (85), acute (36), and chronically (47) infected sites. Atraumatic extraction and implant osteotomy were performed with an ultrasonic surgery device without flap elevation. All sites received the same medication and surgical protocol; infected sites were ultrasonicated during 30 seconds at 72 W. Kaplan-Meyer survival rates were calculated at 1 year. RESULTS: The 1-year survival rates of the noninfected, chronically, and acute infected groups were 98.8, 100, and 94.4%, respectively. The differences were not statistically significant. No implant was lost after loading. All teeth and roots could be extracted in one piece. Drilling at extraction sockets was uncomplicated, without skidding. CONCLUSIONS: Implant survival rates might be similar in infected and noninfected sites when infected sites receive standard medical and surgical treatment and are ultrasonicated. Atraumatic tooth/root extraction and implant placement can be reliably performed with piezoelectric surgery.

[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.

Microbial biofilm modulation by ultrasound: current concepts and controversies.

Biofilm elimination is often necessary during antimicrobial therapy or industrial medical manufacturing decontamination. In this context, ultrasound treatment has been frequently described in the literature for its antibiofilm effectiveness, but at the same time, various authors have described ultrasound as a formidable enhancer of bacterial viability. This discrepancy has found no solution in the current literature for around 9 years; some works have shown that every time bacteria are exposed to an ultrasonic field, both destruction and stimulation phenomena co-exist. This co-existence proves to have different final effects based on various factors such as: ultrasound frequency and intensity, the bacterial species involved, the material used for ultrasound diffusion, the presence of cavitation effects and the forms of bacterial planktonic or biofilm. The aim of this work is to analyze current concepts regarding ultrasound effect on prokaryotic cells, and in particular ultrasound activity on bacterial biofilm.

Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up.

This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.

Osteotome sinus floor elevation technique without grafting: a 5-year prospective study.

AIM: To evaluate the long-term stability of peri-implant bone formation following implant placement without grafting into resorbed posterior maxillae. MATERIALS AND METHODS: Twenty-five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs. RESULTS: All implants fulfilled survival criteria and gained peri-implant bone (mean increase 3.2±1.3mm). Implant protrusion into the sinus decreased from 4.9±1.9mm after surgery to 1.5±0.9mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8mm stabilized over the 5-year observation interval. Twenty implants showed additional peri-implant bone gain following the 1-year control. CONCLUSIONS: Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long-term results.

Atraumatic tooth extraction and immediate implant placement with Piezosurgery: evaluation of 40 sites after at least 1 year of loading.

This paper presents ultrasonic surgery (ie, Piezosurgery) as a new, relevant, and predictable method for performing atraumatic tooth extraction and subsequent implant site preparation. Forty noninfected teeth or roots were extracted in 23 patients and replaced immediately with implants. Extraction consisted of cutting the fibers of the periodontal ligament with vibrating tips of up to 10 mm in depth; the teeth or roots were mobilized afterward with an elevator. All teeth/roots were removed without fracture. Implant osteotomies were performed using conical tips of increasing diameters. During implant placement, notching of the apical third of the palatal wall or the interradicular bridge was performed without complication due to uncontrolled movements of the instrument. After a mean healing period of 2.4 months, all implants were osseointegrated and have been successfully loaded for at least 12 months. By implementing Piezosurgery, extraction can be atraumatic and implant placement can be predictable and undemanding compared to the use of burs, which can lead to instruments slipping during the procedure.

Split-crest and immediate implant placement with ultrasonic bone surgery (piezosurgery): 3-year follow-up of 180 treated implant sites.

OBJECTIVE: To report and evaluate ultrasonic bone surgery (USBS), also known as piezosurgery, in split-crest procedures with immediate implant placement at 3 years of follow-up. METHOD AND MATERIALS: Sixty-one split-crest procedures were performed, and 180 implants were placed in 43 patients. Initial ridge width varied between 1.5 and 5.0 mm (mean 3.3 +/- 0.7 mm). Bone density was type I (11.1%), type II (27.8%), type III (28.9%), and type IV (32.2%). The USBS device worked with a 20 to 32 kHz vibrating frequency and 90 W peak power. RESULTS: Mean split length was 14.8 +/- 10.8 mm; mean final ridge width was 6.0 +/- 0.4 mm. At second-stage surgery, five of 180 implants failed to osseointegrate (2.8%), all in the maxilla. Also at second-stage surgery, the success rate of the implants placed simultaneously to the split crest performed with USBS was 97.2% overall, 95.1% in the maxilla and 100% in the mandible. No loaded implant failed during the 3-year follow-up; respective success rates were unchanged. CONCLUSIONS: USBS is predictable to perform split-crest procedures, without risk of bone thermonecrosis; it decreases the risk of soft tissue alteration. Bone-cutting efficiency was satisfactory with the present USBS device because of its elevated ultrasonic vibrating power, especially in soft type IV bone.

Placement of tapered implants using an osteotome sinus floor elevation technique without bone grafting: 1-year results.

PURPOSE: Achieving implant primary stability in poor-density bone is difficult when the available bone height is less than 6 mm. This study assesses the 1-year clinical performance of tapered implants in sites of reduced height in combination with osteotome sinus floor elevation without bone grafting material. MATERIALS AND METHODS: An osteotome sinus floor elevation procedure without grafting material was performed in the atrophic posterior maxilla. Tapered implants were placed in maxillary sites with residual bone height of 1 to 6 mm. Implant primary stability was assessed by finger pressure exerted on the implant. Bone gain in the elevated sinus and crestal bone loss were evaluated at 1 year via radiographs. RESULTS: Fifty-four tapered implants were placed in 32 patients and were loaded after a mean of 4.2 +/- 1.6 months. The mean maxillary residual bone height was 3.8 +/- 1.2 mm. All implants achieved primary stability, and all were successfully loaded. At the 1-year radiographic control, the mean bone gain within the sinus was 2.5 +/- 1.7 mm and the mean crestal bone loss was 0.2 +/- 0.8 mm. CONCLUSIONS: In the atrophic posterior maxilla, primary stability can readily be achieved with tapered implants, even when the mean residual bone height is 3.8 mm. Despite limited bone support and lack of grafting material, all loaded implants were clinically stable, and crestal bone loss was limited. A net bone gain of 2.3 +/- 1.8 mm was observed. Survival and success rates were 100% and 94.4%, respectively. Elevation of the sinus membrane without the addition of bone grafting material led to bone formation beyond the original limit of the sinus floor.

Unconventional implant treatment: I. Implant placement in contact with ankylosed root fragments. A series of five case reports.

OBJECTIVE: Implant treatment presumes that implants are placed in bone, without any contact with root. At ankylosed teeth, complete root removal is often invasive; subsequently, the sites require additional augmentation procedures to complete the treatment. The aim of this paper is to report on a series of five cases that have been treated with an approach that avoided extractive invasive surgery and bone damage. MATERIAL AND METHODS: The procedure consisted of preparing the osteotomy site by drilling through the root. At the end of the drilling sequence, the root fragments that were not removed were deliberately left at the osteotomy site. Their mobility was checked with a dental pick and when stable an implant was placed in contact with them. The sites were required to be asymptomatic and inflammation free. Ankylosed teeth were replaced with 13-15-mm-long Osseotite implants, four in the anterior maxilla and one in the anterior mandible. RESULTS: All implants healed uneventfully; they have been now loaded for a period of 12-42 months. On peri-apical radiographs, appearance of the bone-implant interface was similar to osseointegrated implants. The remaining root fragments were visible, in contact with the implants; no specific pathological sign could be detected. A limited resorption of dentine was found at one site after 4 years. CONCLUSION: This series of cases suggests that implants placed in contact with ankylosed root fragments might not interfere with implant integration or harm occlusal function, at least in the mid-term. More cases are warranted before this procedure might be considered as a reliable clinical option when, at ankylosed teeth, one wishes to avoid an invasive extraction surgery.

Unconventional implant placement. 2: placement of implants through impacted teeth. Three case reports.

The aim of this paper is to report on three patients who received unconventional implant treatment because of the presence of impacted teeth. To avoid invasive surgical removal of the impacted teeth and delayed implant treatment, implants were placed through the impacted teeth. Of the seven implants placed into four impacted teeth, all healed uneventfully except a short (8.5-mm) implant that became mobile after 4 months. One and three implants now have been loaded for 3.5 and 2 years, respectively. The two other implants were removed after 6 months of uneventful healing. These cases, although limited in number, suggest that implant placement through an impacted tooth might not interfere with implant integration or harm occlusal function, at least in the short term. More study is warranted before this unconventional procedure might be considered as a possible clinical option when, at an impacted tooth site, clinicians seek to avoid invasive surgery.