The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study.

AIM: The present study clinically analyzes implant survival of immediate implant placement cases using the drilling through roots (DTR) technique for anatomically-guided implant site preparation, as an aid to placing immediate dental implants in multi-radicular teeth. MATERIALS AND METHODS: This clinical analysis utilized patients' electronic dental records who underwent immediate implant surgery using the DTR technique. All immediately placed implants were followed up regularly every year, after restoration. Implant survival was assessed with the Albrektsson et al. criteria. Inferential statistics was performed using SPSS v 21(IBM Corp., Armonk, NY) software. The Kaplan-Meier survival analysis was done to assess the implant survival probability. RESULTS: A total of 250 records of dental implants placed in 227 subjects using the DTR technique were considered. Results showed that the mean survival duration of implants was found 63.29 months and the median survival duration to be 55 months. A 100% success rate was seen in implant fixed bridge cases, and about 97.6% success was seen in single crown cases. No significant difference was seen in the survival rates during the follow-up period when compared according to the quadrants/site of implant placement. CONCLUSION: The findings concluded that tooth-guided rapid implant placement is a unique strategy for convenient and safe insertion, providing accurate three-dimensional positioning. CLINICAL SIGNIFICANCE: The DTR method is a novel approach that facilitates accurate positioning and angulation of the implant bed preparation by stabilizing and guiding the osteotomy drills using the retained root. As a result, it enables optimal implant positioning at multirooted extraction sites. How to cite this article: Mahesh L, Miselli A, Bhasin MT, et al. The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study. J Contemp Dent Pract 2024;25(5):432-439.

Autologous Tooth Dentin Graft: A Retrospective Study in Humans.

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets' preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties.

Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study.

AIM: The aim of the study was to evaluate the survival rate of two diverse implant systems with different implant surfaces with the same geometrical design. MATERIALS AND METHODS: One hundred fifty patients were included in the study in which 95 were males and 55 were females and 150 implants were placed using indirect sinus floor elevation technique and only one implant was placed in each subject and they were categorized into two groups of 100 in group A and 50 in group B as per two different implant systems. At review appointments, implants were tested clinically and radiographically and were examined for signs of infection. The patients were examined periodically after placement of the implants, and follow-up was conducted annually. RESULTS: Results of the Chi-square analysis showed no significant association between the type of implant surface and rate of success or failure of the implant. There was no significant difference between the observed and expected frequency of successful implants in group A as well as group B, indicating that the surface type of implant had no significant association with the success of the implant in group A and B. CONCLUSION: To date, there is no consensus in the literature regarding the best surface and even on the macrotopography of the implants for better osseointegration. However, Surface treatments improve the result of osseointegration, especially in the early stages, benefiting bone affixation with qualitative and quantitative enhancements. In the present study, we achieved clinical success with both kinds of implant surfaces however Bioetched implant surface showed promising results comparable to Tiunite surface of Nobel BioCare Implants. In the future, more case-controlled studies with longer follow-up are needed to validate the results of the present findings.

Effect of Addition of Platelet-rich Plasma to Calcium Phosphosilicate Putty on Healing at 9 Months in Periodontal Intrabony Defects.

BACKGROUND AND OBJECTIVE: Combination of platelet-rich plasma (PRP) and bone substitutes for the surgical treatment of periodontal intrabony defects is based on a sound biologic rationale; however, the clinical results indicative of the synergistic effect of PRP remain ambiguous. The objective of the present study was to clinically and radiographically evaluate the use of calcium phosphosilicate (CPS) putty alone and in combination with PRP in the treatment of periodontal intrabony defects. MATERIALS AND METHODS: The study was performed at an outpatient facility at a teaching dental institute in north India. A split-mouth design was employed to assess the clinical parameters and radiographic bone fill following the use of CPS putty with and without PRP in patients scheduled for surgical periodontal treatment of intrabony osseous defects. Each defect was randomized to receive treatment with open flap debridement, with CPS putty alone (Group PUT), or open flap debridement with CPS putty and PRP (Group PRp). Probing pocket depth (PPD), plaque index (PI), gingival index (GI), and clinical attachment levels (CALs) were recorded at the investigated sites utilizing custom-made reference guides for measurement reproducibility. Standardized periapical radiographs were also obtained to evaluate defect fill at the surgical sites. RESULTS: Twenty patients each with at least two defects located in different quadrants were enrolled. The reduction in PPD from baseline to 1st, 3rd, 6th, and 9th month was found to be significant (p < 0.05). The percent reduction in PPD among PUT group was 57.18 ± 10.71% and among PRP group was 51.39 ± 12.60%. No statistically significant difference was observed in the percent reduction in PPD among two groups at 9 months (p = 0.48). Sites in both groups exhibited statistically significant reductions in PI and GI that were maintained throughout the study period. Similar results were seen while measuring CAL. CONCLUSION: Calcium phosphosilicate Putty alone provides significant improvement in outcomes for the treatment of periodontal intraosseous defects. The addition of PRP to CPS putty does not seem to provide any additive benefit to treatment and the additional surgical time and trauma can be avoided.

Periotest values of implants placed in sockets augmented with calcium phosphosilicate putty graft: a comparative analysis against implants placed in naturally healed sockets.

AIM: To measure implant stability using periotest values of implants placed in sockets augmented with calcium phospho-silicate putty (CPS Putty) as compared with implant stability in naturally healed sockets. MATERIALS AND METHODS: Twenty two sockets were implanted with CPS Putty immediately after extraction. The sockets were re-entered after a healing period at 5 to 6 months (average 5.3 months) for implant placement. Periotest values were recorded during implant insertion to assess primary stability. These were compared with the Periotest values of 26 implants placed in 22 patients, with naturally healed sockets. RESULT: Periotest values were significantly lower in the grafted group, indicating better implant stability in sites grafted with CPS putty. CONCLUSION: Implant stability seems to be significantly higher in sockets augmented using CPS putty when compared to nongrafted sites. This suggests that socket grafting with CPS putty may enhance the quality of available bone for implantation.

Extra oral cementation of implant prosthesis: a case report.

Extraoral cementation is a technique that utilizes a stock abutment and a laboratory fabricated crown that is cemented extra orally; the advantage of this technique is that the retained excess luting agent during intraoral cementation, which can be a source of bacterial retention and cannot be observed radio graphically and is not possible to remove with explorer all the time, does not get accumulated and can be trimmed off easily before the final placement of the crown. Thus this technique allows no retention of luting cement, providing better soft tissue contours, no soft tissue inflammation, no retention of plaque and no bone loss. In short it prevents implant failure related to retained cement around implants. This technique provides overall health of peri-implant soft tissues as compared to conventional technique of crown placement where cement retention is a common problem, leading to implant failures.

The Survival Rate of Posterior Immediate Implants in the Maxilla and Mandible: An Observational Retrospective Study of 158 Dental Implants.

BACKGROUND: Immediate implants are popular for the anterior sextants of the mouth and have shown a high success rate for the same. However, their installation in a fresh extraction socket in the posterior segments can also be beneficial to the patients and limit the time for the patient to start the masticatory function. However, there have been contradicting results in different studies. OBJECTIVES: The primary objective of this retrospective study was to establish correlations between factors such as implant dimensions, implant categories, implant location, and various demographic parameters in relation to the longevity of implants. This investigation was conducted through a comprehensive clinical evaluation of immediate implants situated within the molar sections of both the upper (maxillary) and lower (mandibular) jaws. METHODS: Between October 2015 and August 2022, a total of 158 implants were implanted, with 87 males and 71 females undergoing implant placement following tooth extraction. All implants were reinstated between 12 and 18 weeks after they were placed. Inferential statistics were performed using SPSS Statistics version 23 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). The Chi-square test was employed to determine statistical significance (p=0.05) between survived and failed implants in relation to various study factors. Lastly, in order to measure the survival rate under different time periods after implant placement, the life table method and Kaplan-Meier survival rate analysis were used. RESULTS: Success of implants was observed at 149 sites, whereas implant failure was seen at nine sites in total. From placement to loading, the implant failed at five sites, and the cumulative survival rate was found to be 96.83%, from loading to one year, implant failure was seen at three sites, and the cumulative survival rate was found to be 94.9%, from one to two years after loading implant failure was seen at only one site with cumulative survival rate to be 94.93%. From two to three years after loading, implant failure was not seen at any site. CONCLUSIONS: Regardless of implant size or insertion location, rapid implant implantation in fresh extraction sockets can result in predictable clinical outcomes.

The severely atrophic maxilla: Decision making with zygomatic and pterygoid dental implants.

The severely atrophic maxilla can present with some challenges during treatment planning with communication between those performing the surgical and prosthetic aspects of the treatment as well as communication with the patient as to what is being suggested for treatment. This article simplifies the communication and understanding of treating the severely atrophic maxilla and based on the Bedrossian classification gives a guideline for the surgical approach to be adapted based on the patient residual anatomy.

Socket grafting with calcium phosphosilicate alloplast putty: a histomorphometric evaluation.

BACKGROUND: Socket grafting with a bone graft substitute immediately after extraction is essential to preserve the ridge architecture for implant placement. Several bone graft substitutes have been tested for their ability to effectively regenerate osseous tissue in the sockets. Evidence suggests that socket bone typically regenerates during a period of 6 to 8 months or longer, depending on several factors including the original ridge dimensions, type of graft, and the overall systemic health of the individual. The purpose of this study is to histologically evaluate the bone regeneration potential of a novel synthetic calcium phosphosilicate putty (CPS) graft substitute. METHODS: After extraction of the involved teeth, CPS putty graft was placed, and the sockets were covered with a collagen plug. Cores were taken from 20 patients for histological evaluation prior to implant placement. Ten cores were processed decalcified with hematoxylin and eosin (H&E) stain and the remaining 10 were processed undecalcified. Histomorphometric data obtained from both sets is presented. RESULTS: Histomorphometric analysis revealed an average vital bone content of 49.5 (± 20.7). A residual graft content of 4.3% (± 7.8) was observed following a healing time of 4.9 (± 0.8) months. CONCLUSIONS: Clinical and histomorphometric data suggests that CPS putty is a good choice for socket bone regeneration in implant-related surgeries.

Socket preservation with alloplast: discussion and a descriptive case.

Soon after tooth extraction the bone resorption takes place reducing the height and width of alveolar ridge. This produces an altered morphology of the bone unfavorable for implant placement and implant placement becomes impossible without surgical correction. Socket grafting maintains and preserves ridge for implant placement.