Laser-Assisted Therapy for the Treatment of Peri-implantitis. Part I. Clinical Outcomes.

The purpose of this 12-month randomized, controlled clinical trial was to evaluate the efficacy of a monotherapy protocol with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for treatment of peri-implantitis. Twenty patients with 36 implants exhibiting probing pocket depths (PPDs) > 4 mm and evidence of radiographic bone loss (RBL) were randomly divided into two groups. The test group was treated with the Nd:YAG laser, and the control group was managed with mechanical debridement only. Peri-implant clinical parameters were recorded at baseline and at 12 months after treatment. PPD, RBL, and bleeding on probing showed improvements after 12 months in the test and control groups. The laser therapy provided additional benefits of greater reduction in PPDs and increased bone level with no adverse outcomes. The results demonstrated that laser therapy could be a valuable modality for the treatment of peri-implantitis.

Novel Approach to Overcome Limitations Associated With Immediate Implant Placement: Osteotome Technique.

This case series introduces a novel osteotome technique as an alternative to conventional drilling protocols for immediate fixtures. Immediate implant placement is associated with significantly less bone-to-implant contact, and navigating the anatomy of the socket can be difficult. Osteotomy drills remove already-limited bone following atraumatic extractions. The osteotome technique has been introduced as an alternative approach to prepare the osteotomy in the appropriate position relative to the socket apex and surrounding alveolar walls. The surgical technique and case reports demonstrating it are presented, highlighting the technique's benefits.

Effectiveness of Adjunctive Use of Low-Level Laser Therapy and Photodynamic Therapy After Scaling and Root Planing in Patients with Chronic Periodontitis.

The aim of this split-mouth, randomized controlled clinical trial was to evaluate the efficacy of low-level laser therapy (LLLT) and photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) in treatment of chronic periodontitis. Each quadrant was categorized into control group (SRP alone; two quadrants per patient), test group 1 (SRP + PDT), and test group 2 (SRP + LLLT. The test groups showed significantly higher reductions in Gingival Index, probing depth, and clinical attachment level as well as reductions in Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans counts at 1-, 3-, 6-, and 9-month follow-ups when compared with the control group.

Lip Repositioning with Vestibular Shallowing Technique for Treatment of Excessive Gingival Display with Various Etiologies.

Improvement of smile esthetics is a major goal of modern dentistry. Various treatment modalities have been proposed to correct excessive gingival display (EGD), depending on the identified etiologies. This study reports on the clinical and patient-centered outcomes of a novel lip repositioning technique with vestibular shallowing approach in the treatment of three types of EGD with varying etiologies. Periosteal fenestration with cicatrization (scarification) was performed at the mucogingival junction to ensure the stability of esthetic outcomes. Suspensory triangular sutures and extraoral tissue stabilization tapes were used to facilitate the cicatrization process during the healing phase of this novel technique. Postoperative clinical examination revealed 84% reduction in gingival display that remained stable for 13 to 16 months with a high level of patient satisfaction.

Comparison of Osteotome and Conventional Drilling Techniques for Primary Implant Stability: An In Vitro Study.

It may be difficult to achieve primary stability in the posterior maxilla because of poor quality and quantity of bone. Studies have shown that the osteotome technique immediately increases bone density thereby increasing primary stability. An in vitro study was conducted to compare the stability achieved by the osteotome and conventional drilling techniques in low density bone. Forty endosseous implant fixtures (n = 40) were inserted in a solid rigid polyurethane block simulating low density (D3) bone. The implants were divided into 4 groups to test 2 variables: (1) implant length (10 mm or 13 mm) and (2) preparation of osteotomy (conventional drilling or osteotome technique). Insertion torque (IT) and resonance frequency analysis (RFA) were measured for each implant. Statistical analysis using one-way ANOVA and Tukey post hoc test was done to study IT and RFA data of the 4 groups. Pearson Correlation test was used to determine the correlation between IT and RFA values of the implants. The IT and RFA values were statistically significant higher using the osteotome technique as compared to conventional drilling (P < 0.0001). Statistically significant higher values were also found for IT and RFA of 13 mm implants as compared to 10 mm implants. A significant correlation was found between insertion torque and RFA values in all 4 groups (r = 0.86, P < 0.0001). The conclusion was that the osteotome technique significantly increased primary stability.

Resonance frequency analysis (RFA) and insertional torque (IT) stability comparisons of implants placed using osteotomes versus drilling techniques: A preliminary case study.

OBJECTIVE: Poor bone density in the posterior maxilla often presents challenges in achieving implant stability. Insertional torque (IT) and resonance frequency analysis (RFA) have been used to objectively monitor the process of osseointegration. This study was designed to quantitatively assess the primary and secondary stability of fixtures placed using the osteotome or conventional drilling technique, in soft bone. The study also assessed if there was a correlation between IT and RFA measurements. METHOD AND MATERIALS: Sixteen implants of a standardized dimension were randomly assigned to two groups: osteotome or conventional drilling. IT was taken at the time of placement. RFA was recorded at baseline and 30, 60, and 90 days. RESULTS: Average IT and RFA were 36 Ncm (range 25-45 Ncm) and 61.5 implant stability quotient (ISQ; range 44-72 ISQ), respectively. RFA in the osteotome group increased from day 0 to day 30 (63.5 to 68.0 ISQ) whereas it decreased in the conventional drilling group (65.9 to 56.6 ISQ). At 90 days, both groups showed similar results. No statistically significant difference between IT and RFA was found across all time intervals. CONCLUSION: IT and ISQ values were shown to fluctuate depending on various local anatomical factors such as density of the bone. Additional clinical and radiographic studies are needed in type 1 to 4 bone to determine the utilization of RFA and IT for routine implant surgery. Adequate stability measurements are critical for implant placement. Future guidelines and knowledge of stability and bone density values may help in establishing loading protocols and improving success rate.

Reconstruction of the narrow ridge using combined ridge split and guided bone regeneration with rhPDGF-BB growth factor-enhanced allograft.

In clinical situations where the presence of severe horizontal ridge deficiencies precludes simultaneous implant placement and bone augmentation, a staged approach may be desirable to allow optimal implant placement. Numerous therapeutic options are available for the treatment of the horizontally deficient ridge. With advances in tissue engineering, the use of growth factors can significantly improve wound healing with more rapid bone formation and maturation. These case reports demonstrate a technique that enhances the predictability of horizontal bone gain with reduced surgical trauma and postoperative complications. Recombinant human platelet-derived growth factor BB (rhPDGF-BB) in combination with particulate allograft is used to stimulate the proliferation and migration of osteogenic cells. A ridge split technique with vertical bone incisions allows expansion and mobilization of the buccal plate, creating a space that will contain the particulate graft material. Decortication of the mobilized buccal plate will create pathways to allow cellular and vascular access for enhanced maturation. Additional graft material is placed lateral to the mobilized buccal plate to increase apical ridge width. The use of piezoelectric surgery enables a precise crestal bony incision in severely deficient ridge widths and aids in faster wound healing. This study discusses the technique and the recommended therapeutic considerations to ensure predictable regeneration of adequate bone for optimal implant placement in horizontally deficient ridges.

Novel decision tree algorithms for the treatment planning of compromised teeth.

In clinical practice, dentists are faced with the dilemma of whether to treat, maintain, or extract a tooth. Of primary importance are the patient's desires and the restorability and periodontal condition of the tooth/teeth in question. Too often, clinicians extract teeth when endodontic therapy, crown-lengthening surgery, forced orthodontic eruption, or regenerative therapy can be used with predictable results. In addition, many clinicians do not consider the use of questionable teeth as provisional or transitional abutments. The aim of this article is to present a novel decision tree approach that will address the clinical deductive reasoning, based on the scientific literature and exemplified by selective case presentations, that may help clinicians make the right decision. Innovative decision tree algorithms will be proposed that consider endodontic, restorative, and periodontal assessments to improve and possibly eliminate erroneous decision making. Decision-based algorithms are dynamic and must be continually updated in accordance with new evidence-based studies.

Maintaining space in localized ridge augmentation using guided bone regeneration with tenting screw technology.

Prosthetic guided implant surgery requires adequate ridge dimensions for proper implant placement. Various surgical procedures can be used to augment deficient alveolar ridges. Studies have examined new bone formation on deficient ridges, utilizing numerous surgical techniques and biomaterials. The goal is to develop time efficient techniques, which have low morbidity. A crucial factor for successful bone grafting procedures is space maintenance. The article discusses space maintenance tenting screws, used in conjunction with bone allografts and resorbable barrier membranes, to ensure uneventful guided bone regeneration (GBR) enabling optimal implant positioning. The technique utilized has been described in the literature to treat severely resorbed alveolar ridges and additionally can be considered in restoring the vertical and horizontal component of deficient extraction sites. Three cases are presented to illustrate the utilization and effectiveness of tenting screw technology in the treatment of atrophic extraction sockets and for deficient ridges.

Considerations for a staged approach in implant dentistry.

Full-arch and partial reconstruction is demanding for the clinician and a challenge for the patient. Traditionally, teeth are extracted, and implants are placed; the patient wears a provisional removable prosthesis during implant osseointegration. The patient is left to deal with a difficult transition from a fixed dentition to a removable one, albeit temporarily. This drastic alteration can generate functional, emotional, and esthetic changes for the patient, thereby making a difficult time even more challenging. Reconstructing the dentition through a staged approach has been documented and involves strategic extractions along with the placement of several implants, but leaves select abutment teeth for a fixed provisional prosthesis. This allows for the provisional prosthesis to be tooth-supported during implant integration and later converted to an implant-supported prosthesis. In this manner, the patient will benefit from a fixed provisional prosthesis throughout the treatment process. A staged approach is contingent upon a thorough periodontal and prosthetic evaluation and work-up. Success requires proper communication between the periodontist, surgeon, restorative dentist, laboratory, and patient. A team approach is necessary for success. The protocol, advantages, and disadvantages for a staged approach to a full-arch implant-supported reconstruction are discussed. The authors also present a case to show how the staged approach can be used for sextant or quadrant rehabilitation.

Sequencing osteotomes to overcome challenges presented by deficient bone quantity and quality in potential implant sites.

The combination of inadequate bone volume, poor bone quality, and elevated occlusal forces contributes to the posterior maxilla being the least predictable site for implant survival. Osteotomes are surgical instruments that have been designed in an attempt to improve bone quantity and quality. Conflicting reports in the literature compare the percentages of bone-to-implant surface contact between the implants placed using osteotomes and conventional drills. However, some studies use different osteotomes that may be harmful to the bone. Innovative pilot intermediary osteotomes used in conjunction with divergent sequential osteotomes to ensure parallelism, expand narrow ridges predictably, safely and significantly internally elevate the sinus, aid in future site development, and assist in immediate implant placement are introduced. The hypothesis is that the quality of bone is simultaneously enhanced, but controlled clinical studies are needed to prove this theory.

Alternative to the gold standard for alveolar ridge augmentation: tenting screw technology.

Studies have discussed the potential issues associated with the placement of implants in unfavorable locations. Today, it is possible to optimize implant placement despite the significant ridge resorption that often occurs after tooth extraction. This objective is achievable because techniques exist to augment resorbed alveolar ridges to prerequisite widths and heights for proper implant position. A group of surgical procedures have evolved that are considered to be the gold standard for achieving alveolar ridge width and height augmentation. This article discusses the purported gold standard procedure of onlay block grafts for ridge augmentation and contrasts those grafts with the equally successful, more time- and cost-effective tenting screw technology, in conjunction with guided bone regeneration, which has less morbidity and involves only one surgical site. Three cases are presented to illustrate the utilization and effectiveness of tenting screw technology.