Clinical evaluation and patient related outcomes of one- and two-piece zirconia implants at five years of loading: A case series study.

OBJECTIVE: The objective of this study was to investigate the survival and biological and mechanical complications of one-piece and two-piece zirconia implants at five years of loading. MATERIALS AND METHODS: Consecutive patients receiving zirconia implants were studied, collecting data at five years of loading on their clinical history, peri-implant health status, mechanical complications, esthetic results, and patient related outcomes. RESULTS: The study included 18 patients with 29 implants. The survival rate was 86% in implant-based analysis and 78% in patient-based analysis. There were no cases of peri-implantitis, but mucositis was present in 53% of implants. A mean of 4.1 ± 0.81 mm was obtained for probing depth and 1.6 ± 0.9 mm for crestal bone loss (radiographic assessment). There were no implant fractures. Major (10%) and minor (10%) prosthesis complications were observed. The esthetic outcome was moderate to almost perfect, with a high level of patient satisfaction. No significant association was found between survival rate and the presence of mucositis around one- or two-piece implants or any other study variable. CONCLUSIONS: The survival rate is low for one- and two-piece zirconia implants. Both types of implants demonstrated a low mechanical complication rate. The incidence of periimplantitis is low but mucositis is present in 50%. Patient satisfaction related to esthetics and function is moderate to high. They represent a good option for patients requiring an alternative to titanium implants. CLINICAL RELEVANCE: Zirconia implants appear to be an alternative to the titanium option and may be indicated for patients requiring "metal-free" restorations.

Applications of maxillary tuberosity block autograft.

OBJECTIVE: Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth. CLINICAL CONSIDERATIONS: Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge. CONCLUSIONS: The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects. CLINICAL SIGNIFICANCE: Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.

The four-layer graft technique, a hard and soft tissue graft from the tuberosity in one piece.

OBJECTIVE: Successful immediate implant placement in the maxillary anterior zone continues to be a challenge. There is an uncertainty on whether it should be performed on patients with thin gingival phenotype or incomplete buccal plate. This clinical case report describes a novel technique for immediate implant placement with simultaneous hard and soft tissue augmentation. CLINICAL CONSIDERATIONS: This technique employs a combined epithelialized-subepithelialized connective tissue graft and cortical-cancellous autogenous bone graft for the treatment of incomplete buccal plate at an extraction site. Significant horizontal bone regeneration appears to have been achieved as well as soft tissue augmentation for a central incisor in a single surgical step. Following three and a half years, gingival contours and bone augmentation were stable with a pleasant esthetic result. CONCLUSIONS: The use of the four-layer tissue graft for immediate implant placement can be suggested to improve hard and soft tissues in a single procedure. CLINICAL SIGNIFICANCE: The use of the four-layer graft technique has shown to be successful regarding function and esthetic outcomes in anterior immediate implant placement. It reduces surgical interventions and treatment time and minimizes soft tissue recession and bone resorption.

Single extraction socket classification for aesthetic outcomes (CEO).

PURPOSE: Accurate extraction socket evaluation is crucial for aesthetic success with immediate implant placement. The present authors propose a socket classification system to assist selection of the approach most likely to offer an optimal aesthetic outcome. The objectives of this study were to describe this novel system and evaluate the inter-rater agreement. MATERIALS AND METHODS: Socket type identification was based on three parameters: the position of the gingival margin in relation to the homologous tooth, the morphology of the buccal bone plate, and the interproximal attachment level (the latter two were evaluated through gingival probing). These data were used to identify four socket types, including three from a widely applied classification system, which were subdivided into two subtypes to give types 1A, 1B, 2A, 2B, 3A, 3B, 4A and 4B. After establishing a 'gold standard' classification, a questionnaire was sent to 50 postgraduate students and 45 experienced dental practitioners. RESULTS: A simple system was used to classify single extraction sockets from observations of marginal and interproximal tissues. In a sample of 95 examiners, the percentage agreement with gold standard classifications was 78.7% ± 0.023% [0.56% to 0.98%] and was not significantly influenced by the examiner's level of clinical experience (P > 0.05). Treatment recommendations were proposed for each socket type. CONCLUSION: The single extraction socket classification for aesthetic outcomes simplifies the prediction of aesthetic outcomes and provides a rational basis for the approach to each socket type.

Autotransplantation of Maxillary Third Molar with Its Attached Buccal Cortical Plate Combined with a Connective Tissue Graft.

INTRODUCTION: Tooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3). METHODS: A 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area. RESULTS: At 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption. CONCLUSIONS: The use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.

Impacted Maxillary Canine with Curved Apex: Three-Dimensional Guided Protocol for Autotransplantation.

INTRODUCTION: Maxillary canines play a crucial role in dental and facial aspect, arch expansion, and efficient occlusion. When surgical exposure measures cannot be executed or the patient does not agree to take the treatment, autotransplantation should be considered. The aim of this case report was to describe a novel surgical technique using virtually planned three-dimensional (3D)-printed templates for guided apicoectomy and guided drilling of the recipient site for autotransplantation of an impacted maxillary canine with a curved apex. METHODS: A 42-year-old man complaining of pain and increased mobility in the maxillary left primary canine came to the clinic. Autotransplantation of the impacted canine was completed using altered methods from guided implant surgery to manufacture 3D-printed templates. After a full-thickness mucoperiosteal flap elevation, the surgical template for the guided osteotomy and apicoectomy was inserted. This 3D-printed guide allowed the clinician to perform a quick and precise removal of the curved apex, providing an atraumatic extraction of the impacted canine throughout the cyst. Three further 3D surgical guides for implant burs and a 3D replica tooth were printed to modify the recipient socket. After the final position, the tooth was semi-rigid splinted to the adjacent teeth. RESULTS: Follow-up at 2 years showed complete regeneration of the palatal defect and remodeling of the bone surrounding the maxillary canine. CONCLUSIONS: Digitally planned procedures can facilitate the complex execution of an autotransplantation, reducing the treatment chair time and the morbidity for the patient as well as increasing the predictability of the result.

Autotransplantation of impacted maxillary canines into surgically modified sockets and orthodontic treatment: a 4-year follow-up case report.

The permanent maxillary canine is the second most frequently impacted or displaced tooth. The standard treatment for an impacted canine includes, among other things, surgical exposure and orthodontic alignment. Surgical techniques for this procedure vary depending on whether the tooth is labially or palatally impacted, while orthodontic techniques vary according to clinical judgment and experience. Autotransplantation is a treatment alternative for impacted canines with complete root formation. The success of tooth transplantation depends on the vitality of the periodontal ligament (PDL) attached to the donor tooth, and its viability decreases when it is exposed extraorally. This article reports on maxillary canine autotransplantations combined with connective tissue grafts (CTGs) and orthodontics. The recipient mesiodistal space was created orthodontically and the recipient socket was prepared using dental implant drills. Following transplantation, bone defects were grafted using guided bone regeneration (GBR). At 4 years post-transplantation, the soft tissue level was stable and periapical radiographs showed a practically normal contour of the alveolar crest around teeth 13 and 23. The two permanent canines presented no root resorption and ankylosis, and no signs of inflammation or bleeding were observed. The procedure used in this case report demonstrates that canine transplantation combined with GBR, plastic surgery procedures, and orthodontic treatment may yield acceptable and predictable esthetic results.

Autotransplantation of Mandibular Third Molar with Buccal Cortical Plate to Replace Vertically Fractured Mandibular Second Molar: A Novel Technique.

Tooth replacement often leads to inadequate vertical volume in the recipient site bone when a tooth has been extracted because of a vertical root fracture (VRF). This case report presents the autotransplantation of a mandibular third molar (tooth #32) with the attached buccal cortical plate to replace a mandibular second molar (tooth #31) diagnosed with a VRF. After extraction of tooth #31, the recipient socket was prepared based on the size measured in advance with cone-beam computed tomographic imaging. The precise and calculated osteotomy of the cortical bone of tooth #32 allowed for the exact placement of the donor tooth in the position of tooth #31. The total extraoral time was only 25 minutes. The block was fixed to the recipient socket with an osteosynthesis screw and splinted with a double resin wire for 8 weeks. At the 6-month follow-up, the screw was removed, and the stability of the tooth and the regeneration obtained throughout the vestibular area were confirmed. At the 2-year follow-up, the transplanted tooth was asymptomatic and maintained a normal bone level. Advantages of autotransplantation over dental implants include maintenance of proprioception, possible orthodontic movements, and a relatively low cost. This case report demonstrates that an autotransplantation of a third molar attached to its buccal cortical plate is a viable option to replace teeth with a VRF.