Thermal Testing of Titanium Implants and the Surrounding Ex-Vivo Tissue Irradiated With 9.3um CO2 Laser.

PURPOSE: To measure the temperature rise and surface damage of titanium dental implants and the surrounding tissue in a pig jaw during 9.3-µm carbon dioxide (CO2) laser irradiation at various durations of time. MATERIALS AND METHODS: Thermal analysis tests were performed on 12 implants with the same surface. Twelve implants mounted alone or in pig jaws were laser-irradiated with a 9.3-µm CO2 laser using 3 different power settings. The temperature of the implant body and the proximal tissues was measured with a J-Type Thermocouple after being laser-irradiated with 3 different power setting for 30, 60 seconds, and 2 minutes. Scanning electron microscope (SEM) and digital microscope images were also taken of the all the implants before and after laser irradiation to detect the presence or absence of surface damage. RESULTS: Temperature analysis showed that in all cases the implant and the proximal tissue temperatures remained around the start temperatures of the implant and tissues with fluctuations of ±3°C but never reached the upper threshold of 44°C, the temperature at which thermal injury to bone has been reported. Digital and SEM images that were taken of the implants showed an absence of surface damage at the cutting speed of 20% (0.7 W); however, cutting speeds of 30% to 100% (1.0-4.2 W) did yield surface damage. CONCLUSIONS: Laser irradiation of titanium implant surfaces using a 9.3-µm carbon dioxide laser with an average power of 0.7 W showed no increase in thermal temperature of the implant body and tissue temperatures as well as no evidence of implant surface damage.

Epicrestal and subcrestal placement of platform-switched implants: 18 month-result of a randomized, controlled, split-mouth, prospective clinical trial.

OBJECTIVES: To evaluate the changes in marginal bone levels (MBL) and soft tissue dimension around platform-switched implants with the implant-abutment junction (IAJ) placed at the crest or 1.5-2 mm subcrestally. MATERIALS AND METHODS: In all, 96 platform-switched implants were placed in either the posterior maxilla or mandible in 48 partially edentulous patients in a split-mouth study. All implants were provisionally restored after 4-5 months and definitively after 6 months (T6). Radiographic assessment of MBL was assessed at implant placement (T0), T6, 12 months (T12), and 18 months (T18) after placement. Mid-buccal soft tissue and papilla measurements were performed at T6, T12, and T18. RESULTS: In all, 43 patients with 86 implants completed the study. The T18 examination showed an implant survival rate of 100% in both groups. Analysis showed that MBL varied as a function of IAJ location, which indicated more coronal bone levels with subcrestal (2.39 ± 0.08 mm) than with epicrestal placements (0.88 ± 0.08 mm) (p < .05). Greater average marginal bone loss was found in the subcrestal group (0.40 ± 0.07 mm) compared to the epicrestal group (0.13 ± 0.08 mm) although no statistically significant difference was found at T18 (p > .05). Levels of mid-buccal soft tissue had no significant changes over time, regardless of group (p > .05). There was a significant difference in increase in papilla between T6 and T12 and T18 (p = .005 and .001), but not between T12 and T18 (p = .61). These papilla levels and changes were similar between groups (p > .05). CONCLUSIONS: The MBL changes around platform-switched implants with same geometry were not affected by the epicrestal or subcrestal location of the IAJ. Furthermore, the location of the IAJ did not affect the implant survival and soft tissue dimensions. However, no bone loss was located apical to the IAJ when the implants were placed subcrestally.

Long-Term Implant Survival After 100 Maxillary Sinus Augmentations Using Plasma Rich in Growth Factors.

PURPOSE: To identify determinants of long-term implant survival after sinus augmentation procedure (SAP) using a combination of plasma rich in growth factors (PRGF) and graft material. MATERIALS AND METHODS: Patients were included in this retrospective study if they underwent SAP through a lateral wall approach using PRGF in combination with mainly xenograft, and received implants restored for at least 1 year. Sociodemographic, behavioral and implant characteristics (clinical factors, implant details, surgical details, prosthesis details, and complications) were analyzed. RESULTS: Sixty-seven patients received 217 implants in 100 augmented sinuses. The mean follow-up was 7.2 years. Overall, 22 implants failed in 15 patients (90% cumulative implant survival). Multivariable models showed greater implant survival with implants placed with ≥5 mm of residual crestal bone height (RBH) compared with those placed with <3 mm of RBH. There was also an improvement in survival comparing implant lengths. In addition, immediate loading of implants significantly increased the risk of implant failure. CONCLUSION: The use of PRGFs for maxillary sinus grafting may be an effective and safe treatment option for the rehabilitation of atrophic edentulous posterior maxillae. However, randomized clinical trials are needed to confirm these findings.

The use of 3D models to improve sinus augmentation outcomes - A case report.

Sinus augmentation is a predictable procedure that is often required when restoring the posterior maxilla with dental implants. Even with high success rates, careful pre-surgical planning is crucial. A 3D model is a valuable aid for the clinician as it allows for pre-operative simulation, which can reduce surgical time, reduce the risk of intra-operative complications and decrease the potential for error. The aim of this case report is to focus on how such a model is useful when undertaking a sinus augmentation procedure with simultaneous implant placement.

Twenty years of enamel matrix derivative: the past, the present and the future.

BACGROUND: On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS: This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.

Successful Surgical Protocols in the Treatment of Peri-Implantitis: A Narrative Review of the Literature.

BACKGROUND: The aim was to identify and evaluate those surgical protocols reporting on positive clinical outcomes for treating peri-implantitis with 12 or more months of follow-up. Method of surface decontamination (SDC) was evaluated for any correlation with outcomes. RESULTS: A literature search was performed of all articles published in English between January 1, 2001 and April 30, 2015. Of the 639 identified, 26 satisfied the inclusion criteria. Outcomes reported on included reductions in bleeding on probing (BoP) and probing depth (PD), mean radiographic bone fill (RBF), and mean change in marginal soft tissue levels (MR±). Methods of SDC included mechanical debridement (MD) with and without saline use, MD plus laser or photodynamic therapy, MD with air powder abrasion, MD with chemotherapeutic implant surface decontamination, and combination approaches. The results suggested that various methods of SDC were effective. Heterogeneity of the studies made it impossible to determine correlations between clinical outcome and SDC method. Most studies over 12 months reporting better treatment outcomes employed a bone replacement. Additionally, studies where patients with periodontitis were treated before their peri-implantitis care also had better outcomes. CONCLUSION: The current review failed to reveal any correlation between any particular method for SDC or defect treatment protocol and positive clinical outcomes. Further comparative studies are warranted to determine the most appropriate approach for both of these topics.

Histomorphometric Analysis of a Biopsy Harvested 10 Years After Maxillary Sinus Augmentation With Anorganic Bovine Bone Matrix and Plasma Rich in Growth Factors: A Case Report.

PURPOSE: To evaluate the histologic and histomorphometric data 10 years after grafting of maxillary sinus in a case using anorganic bovine bone matrix (ABBM) and plasma rich in growth factors (PRGF). MATERIALS AND METHODS: Histomorphometric measures were performed for newly formed bone, ABBM particles remnants, marrow spaces, and the presence of osteoblastic and osteoclastic activity. RESULTS: Histologic analysis showed ABBM particles surrounded by new compact and mature vital bone. Osteocytes were noted within lacunae. Some osteoblastic and osteoclastic activity could be identified. The histomorphometric results were 21.7% of newly formed bone, 33.9% of ABBM, and 44% was composed of marrow spaces. CONCLUSIONS: After 10 years postoperatively, the histologic evaluation of this case report demonstrated slow replacement of the ABBM particles by newly formed bone, even with the addition of PRGF. The residual ABBM particles were found in close contact to the newly formed bone.

A new technique to identify the location of the mucogingival junction on computer tomographic scans before implant placement.

A new technique is presented to identify the location of mucogingival junction (MGJ) on CT scans before implant placement. This case report describes the step-by-step fabrication of a radiographic template, which when used in conjunction with CT scans enables the clinician to locate the position of MGJ before implant placement and predict the amount of keratinized tissue (KT) that will be present around an implant. Using this technique, the operator can determine whether or not flapless implant surgery may be a treatment option and whether simultaneous soft tissue augmentation will be necessary at the time of implant placement to establish an adequate band of KT.

Immediate loading with fixed implant-supported restorations in an edentulous patient with an HIV infection: a case report.

BACKGROUND: Oral rehabilitation of edentulous patients with implants that are immediately loaded is a viable treatment alternative today; however, the immediate loading protocol has not been extensively documented in HIV-seropositive patients. METHODS: This clinical case report presents a surgical and prosthetic implant-supported immediate loading protocol in an edentulous HIV-seropositive patient (CD4 >200 and T4/T8: 0.99). Eight implants were placed in each jaw, and no ridge augmentation procedures were required. All the implants were connected with abutments, and a temporary fixed restoration was placed immediately after surgery. The final fixed reconstruction was cemented after 10 weeks of loading. RESULTS: All implants showed no clinical signs of mobility or infection. Periotest values were evaluated during healing and showed a progressive reduction. Radiological findings showed stable bone levels after an observation period of 4 years. CONCLUSIONS: This case report presents an alternative treatment for the oral rehabilitation of an HIV-positive (but disease asymptomatic) edentulous patient. The concept of immediate loading of implants offers advantages when compared with a traditional treatment modality even in immunocompromised patients who are well controlled.

A Less-Invasive Window Design for Lateral Wall Maxillary Sinus Augmentation for Single Implants.

Maxillary sinus window design is an important factor in sinus augmentation procedures, playing a key role in managing maxillary sinus elevation complications, avoiding the sinus septum, and providing lateral support for the graft material. A less-invasive window design in comparison to conventional maxillary sinus windows was introduced with an "I"-shaped window for single implant placement. However, drawbacks of this window design have included limited instrument accessibility to the anterior sinus and incomplete membrane elevation. The purpose of this case report is to demonstrate a step-by-step surgical procedure for lateral wall maxillary sinus augmentation with a novel "J"-shaped window design for single implants.

Clinical Advantages of Implant Osteotomy through the Remaining Root in Mandibular Premolar Region.

The placement of a dental implant by creating the osteotomy through the remaining root can serve as a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures such as the mental foramen and inferior alveolar nerve in close proximity to the planned osteotomy, and facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area.

A Modified Socket-Shield Technique: Simplifying the Root Sectioning Process.

Socket wall resorption leading to a loss of surrounding bone following tooth extraction has been documented in the dental literature. The use of various socket-shield techniques has been suggested as a solution to this issue. In these approaches, the tooth root is sectioned in two, and the coronal two-thirds of the buccal root is preserved in the socket. This allows the periodontium along with the bundle and buccal bone to remain intact, thus preventing or minimizing bone remodeling. According to the literature, this procedure is highly technique sensitive, especially when it comes to sectioning the root. Additionally, the procedure requires significant time, and several complications may occur, such as fenestration or luxation of the remaining root, requiring its complete extraction. This case report presents a modified socket-shield technique using a trephine bur guided by a computer-designed surgical guide to simplify root sectioning, thus reducing surgical time while increasing predictability of the outcome.

Successful Implant Placement into a Site with Two Previous Failures: A Clinical and Histologic Case Report.

Implants present a predictable fixed option for patients who require tooth extraction. However, complications such as implant failure reduce the success of replacement implant restorations. A patient presented to the Department of Periodontology and Implant Dentistry (New York University College of Dentistry) with pain related to a broken implant-supported prosthesis. Two failed implants were removed, and new implants were placed. After restoration delivery, the patient reported soreness on the implant at site 35 (FDI tooth-numbering system), which was then removed (along with a sequestrum of bone) and sent for biopsy. A new implant was placed and restored successfully at the 1-year follow-up. The purpose of this case report is to demonstrate that with proper planning, surgery, and restoration, a new implant can be successfully placed and restored on a site with two previous failures. Int J Periodontics Restorative Dent 2023;43:167-172. doi: 10.11607/prd.5410.

The Custom Alveolar Ridge Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Posterior Mandible: A Case Report.

The Custom Alveolar Ridge Splitting (CARS) technique was recently reported as a less-invasive treatment option for augmentation of the maxillary anterior area in cases where alveolar width deficiency exists due to bone resorption and remodeling. This technique creates an intraosseous defect to improve success when horizontal ridge augmentation is attempted. The purpose of the present case report was to demonstrate implant placement in an atrophic posterior mandibular site using the CARS technique. This technique was used in the mandibular right second premolar area, followed by placement of a single implant. The restored implant showed stable soft and hard tissue outcomes at 6 months postloading.

Clinical Considerations of Ehlers-Danlos Syndrome for Implant Dentistry: Two Case Reports.

Ehlers-Danlos Syndrome (EDS) is a group of congenital connective tissue disorders that commonly affect joints, muscles, soft tissue, and blood circulation in the affected population. Many oral manifestations are displayed in EDS patients that can include gingival recession, lack of attached gingiva, early severe periodontal disease, and dental caries. However, the literature is limited and oftentimes contradictory regarding dental implants in EDS patients. The aim of this study is to report two successful cases of implants placed in EDS patients, one treated with bone augmentation and both restored with prosthetic implant rehabilitations. Int J Periodontics Restorative Dent 2023;43:e81-e87. doi: 10.11607/prd.5842.

Ehlers-Danlos Syndrome in Prosthodontics, Periodontology, and Implant Dentistry: A Systematic Review of the Literature

Ehlers-Danlos Syndrome (EDS) is one of the most common congenital connective tissue disorders, affecting the synthesis and production of collagen cells. The medical implications for joints, muscles, soft tissue, and blood circulation have been documented in the literature. Many oral manifestations are displayed in EDS patients, including gingival recession, lack of attached gingiva, early severe periodontitis, and dental anomalies and dental caries. However, the literature is limited and oftentimes contradictory, and therefore provides no consensus for guidelines regarding prosthodontic, periodontal, and implant treatment of patients with EDS. Therefore, the aim of this systematic review was to analyze the pertinent literature regarding prosthodontics, periodontology, and implant dentistry in EDS patients.

A Retrospective Study of Implant Placement Lateral to the Inferior Alveolar Nerve (ILIAN) in Severely Atrophic Posterior Mandibular Ridges

Currently, there are several techniques being used in the posterior mandible to increase alveolar bone height and width. However, each of these has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In the current study, 26 implants in 16 patients were successfully placed lateral to IAN and restored with splinted screw-retained prostheses with a follow-up time after loading ranging from 3 months to 6 years. Two patients reported complications. One patient had a temporary paresthesia that resolved 3 months after implant placement and the second patient had minor paresthesia which was reduced after implant removal but remained in a small area on the left corner of her lip.

Treatment of a Soft Tissue Depression with a Xenograft Bone Substitute at the Second Stage of an Implant Procedure: A Case Report.

Following the extraction of a compromised tooth, the edentulous alveolar ridge undergoes physiologic bone remodeling, which may create a bone volume too deficient for implant placement. Guided bone regeneration (GBR) provides a predictable treatment option to increase the alveolar bone volume for implant placement, but a soft or hard tissue deficiency may remain even after this augmentation procedure has been completed. These deficiencies can be especially challenging in the esthetic zone, where patient expectations and esthetics often determine the satisfaction of the treatment outcome. This paper presents a case report of a xenograft bone substitute used at the second-stage surgery and abutment insertion to provide a solution to these deficiencies even after the patient had undergone a GBR procedure, thus improving the esthetic and functional outcomes of the final implant-supported restoration.

The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Maxillary sinus elevation by lateral window approach: evolution of technology and technique.

CONTEXT: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. EVIDENCE ACQUISITION: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. EVIDENCE SYNTHESIS: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. CONCLUSIONS: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.