Staged Approach Involving Orthodontic Implant Site Development With Labial Root Torque and Guided Bone Regeneration: 3-Year Follow-up Case Report.

Restoring periodontally compromised teeth in esthetic zones through dental implant rehabilitation poses significant challenges due to the loss of supporting tissues. This case report describes a staged treatment strategy designed for a 48-year-old woman with advanced chronic periodontitis of the esthetic zone. This approach combined various advanced techniques, including periodontal regeneration, orthodontic implant site development with labial root torque, guided bone regeneration, and soft tissue augmentation. The innovative orthodontic implant site development with labial root torque technique was employed to harness healthy palatal periodontal ligament cells by strategically applying labial root torque in the horizontal labial-palatal direction. This technique uses healthy palatal periodontal ligament cells, which benefits overall periodontal health. The procedure involved gradually shifting hopeless teeth at a rate of 2 mm per month using nickel-titanium wires, thereby maintaining overcorrection for 2 months before extraction. Following successful orthodontic implant site development with labial root torque, the next phase involved guided bone regeneration using a honeycomb-structured titanium membrane. This set the stage for implant placement 6 months later, ensuring a stable foundation for subsequent prosthetic intervention. Soft tissue augmentation was then meticulously performed using an artificial collagen dermis infused with fibroblast growth factor-2, contributing to the overall esthetic outcome. Final prosthesis integration revealed a harmonious blend with the adjacent teeth and gums, underscoring the success of this multidisciplinary approach. This case report provides valuable insights into severe periodontitis in the esthetic field. Our findings highlight the importance of continuously researching and improving procedures for optimal patient care.

Novel Synthetic Carbonate Apatite as a Bone Substitute in Implant Treatments: Case Reports.

Bone graft materials are often used in implant treatment to optimize functional and esthetic outcomes. The requirements for bone grafting materials are the ability to maintain space for bone regeneration to occur and the capability of being resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are a chemically synthetic bone graft material similar to autogenous bone minerals and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments when used alone or in combination with autogenous bone. The clinical findings and the radiographic and histologic assessments in three cases of immediate implant placement and lateral and vertical guided bone regeneration are reported. Despite the short-term follow-ups, histologic findings showed that CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules maintained their morphology around the implant. This limited short-term case report suggests that this bone substitute is effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis.

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2-3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry.

Treatment of Mandibular Class III/IV Furcation Defects with a Combination Plastic Regenerative Technique: A Case Series.

The aim of this present case series investigated the effect of a combination therapy utilizing connective tissue graft (CTG) in the treatment of periodontal regeneration of mandibular Class Ⅲ furcation involvement (FI). Six patients diagnosed with periodontitis stage Ⅲ or Ⅳ (grade A to C), presenting with Class Ⅲ or Ⅳ FI, were treated with fibroblast growth factor 2 and carbonate apatite in combination with CTG. The following clinical parameters were evaluated at baseline and after 6, 12 and 18 months: periodontal probing depth, clinical attachment level, furcation invasion, the radiographic vertical defect depth, and gingival phenotype. Significant improvements in clinical parameters were observed in all treated FI sites. Four Class Ⅲ Fls and one Class Ⅳ Fl obtained complete closure, and one Class Ⅳ furcation was improved to Class Ⅰ. This case series showed the potential of administering combination regenerative therapy for changing the prognosis of hopeless teeth with severe furcation defects.

Novel Synthetic Carbonate Apatite as Bone Substitute in Implant Treatments: Case Reports.

Bone graft materials are often used in implant treatment for optimizing functional and esthetic outcomes. The requirements for bone grafting materials should be that they must be able to maintain space for bone regeneration to occur and must be resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are chemically synthetic bone graft material that are similar to autologous bone mineral and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments using CO3Ap granules in combination with autogenous bone or CO3Ap granules separately. This report will show the clinical findings as well as radiographic and histological assessments in three cases of immediate implant placement, lateral GBR and vertical GBR. These results demonstrated, although it was a short-term report, that in histological findings CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules contributed to maintaining their morphology tissue around the implant. In this limited short-term case report, it was suggested that this bone substitute was effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Resorbable Membrane Pouch Technique for Single-Implant Placement in the Esthetic Zone: A Preliminary Technical Case Report.

The conventional protocol for lateral guided bone regeneration (GBR) in esthetic areas requires the securing of resorbable collagen membranes using titanium cortical bone pins to immobilize bone grafts. These procedures are highly invasive and can increase patient morbidity and discomfort. Herein, we introduce a minimally invasive novel resorbable membrane pouch technique, wherein collagen membranes can be immobilized by securing them to the periosteum without the need of titanium pins. We describe 11 cases of single-immediate- or delayed-implant placement in the atrophic maxilla esthetic zone. All implants were successful and functional without pain or inflammation and with optimal soft-tissue health and esthetics. Radiographic evaluation with cone-beam computed tomography (CBCT) and esthetic assessment using the pink esthetic score (PES) were performed. At the time of implant placement, the average augmented bone width was 2.8 ± 0.6 mm on CBCT analysis. In all cases, resorption of the augmented bone was confirmed with an average of -1.3 ± 0.8 mm. Soft-tissue outcomes were scored 1 year after permanent restoration. The PES score 1 year after treatment was 11.9 ± 1.4. The resorbable membrane pouch technique with immediate or delayed implant placement for buccal dehiscence in the esthetic area can be predictable and is minimally invasive.

Guided bone regeneration assisted by tooth roots with periodontal ligament: Case reports of immediate and staged approaches to implant therapy.

To potentially overcome current challenges in bone augmentation techniques and the limitations of bone graft materials, extracted tooth roots with periodontal ligament (TRPs) were strategically utilized to assist guided bone regeneration (GBR). This strategy sought to take advantage of the autologous and shapable nature of TRPs, along with their space-making and shielding ability, and the tissue conductivity/inductivity of the preserved periodontal ligament (PDL). The present article reports on three cases of TRP-assisted GBR as part of immediate and staged approaches to implant therapy. The first case involves immediate implant placement into the extraction socket of a maxillary central incisor, where a TRP veneer, shaped from the extracted central incisor, was used during simultaneous lateral augmentation. The second case describes a staged approach to lateral bone augmentation for a severe buccal bony defect at the maxillary lateral incisor site, where sectioned blocks/pieces of an extracted third molar TRP were used with other bone graft materials. The third case describes aggressive vertical and horizontal bone augmentation for staged implant placement, where an extracted third molar was sectioned and placed on the native alveolar bone as a buccal and lingual bracket, then filled with bone graft materials. All three cases received final restoration and were shown to be stable and functional at the 3-year follow-up. Osseointegration has been well maintained, and the transplanted TRPs seem to be integrated with the native or regenerated bone or remodeled and replaced by the native bone. Longer-term follow-up studies are required.

Long-term alveolar ossification of connective tissue graft placed around natural teeth: a report of five cases.

Connective tissue graft (CTG) surgery has been performed since the 1980s with the principal aim of root coverage. Various types of CTG surgery have been reported, not only for root coverage but also as a preprosthetic treatment for the prevention of gingival recession and to alleviate gingival discoloration. Although there have been numerous reports on the prognosis of such treatment, few observational case reports of 10 years or more have been published. The present article reports on five patients who were monitored from between 13 to 23 years after CTG surgery through the use of intraoral findings, CBCT, and histologic evaluation. The hypothesis of the present authors is that growth factors are released gradually from connective tissue placed either above or below the periosteum. Furthermore, stimulated by the optimal occlusion of the natural teeth, osteoblasts present on the periosteum and/or alveolar bone surrounding the teeth are stimulated. Similarly, the connective tissue itself ensures that the soft tissue has a certain biologic width. At the same time, it acts as a scaffold, resulting in the tissue being replaced by bone.

Photofunctionalized dental implants: a case series in compromised bone.

PURPOSE: Ultraviolet (UV) light treatment of titanium, or photofunctionalization, has been shown to enhance its osteoconductivity in animal and in vitro studies, but its clinical performance has yet to be reported. This clinical case series sought to examine the effect of photofunctionalization on implant success, healing time, osseointegration speed, and peri-implant marginal bone level changes at 1 year after restoration. MATERIALS AND METHODS: Four partially edentulous patients were included in the study. Seven implants with identical microroughened surfaces were photofunctionalized with UV light for 15 minutes. Osseointegration speed was calculated by measuring the increase in implant stability quotient (ISQ) per month. Marginal bone levels were evaluated radiographically at crown placement and at 1 year. RESULTS: All implants placed into fresh extraction sockets, vertically augmented bone, simultaneously augmented sinuses, or the site of a failing implant remained functional and healthy at 1 year, even with an earlier loading protocol (2.1 to 4.5 months). ISQs of 48 to 75 at implant placement had increased to 68 to 81 at loading. In particular, implants with low primary stability (initial ISQ < 70) showed large increases in ISQ. The speed of osseointegration of photofunctionalized implants was considerably greater than that of as-received implants documented in the literature. Mean marginal bone levels were -0.35 ± 0.71 mm at crown placement and had significantly increased to 0.16 ± 0.53 mm at 1 year, with coronal gains in marginal bone level that surpassed the implant platform. No implants showed marginal bone loss. CONCLUSIONS: Within the limits of this study, photofunctionalization expedited and enhanced osseointegration of commercial dental implants in various clinically challenging/compromised bone conditions. Photofunctionalization resulted in preservation--and often a gain--of marginal bone level, and long-term large-scale clinical validation is warranted.

Success rate, healing time, and implant stability of photofunctionalized dental implants.

PURPOSE: This is the first study to report the clinical outcomes of photofunctionalized dental implants. MATERIALS AND METHODS: This retrospective study analyzed 95 consecutive patients who received 222 untreated implants and 70 patients who received 168 photofunctionalized implants over a follow-up period of 2.5 years. Photofunctionalization was performed by treating implants with UV light for 15 minutes using a photo device immediately before placement. The generation of superhydrophilicity and hemophilicity along with a substantial reduction in atomic percentage of surface carbon was confirmed after photofunctionalization. In both groups, 90% of the implants were placed in complex cases requiring staged or simultaneous site-development surgery. The implant stability was measured at implant placement and loading using the implant stability quotient (ISQ) values; then, the rate of implant stability development was evaluated by calculating the ISQ increase per month. RESULTS: The healing time before functional loading was 3.2 months in photofunctionalized implants and 6.5 months in untreated implants. The success rate was 97.6% and 96.3% for photofunctionalized and untreated implants, respectively. The ISQ increase per month for photofunctionalized implants ranged from 2.0 to 8.7 depending on the ISQ at placement, and it was considerably higher than that of untreated implants reported in the literature ranging from -1.8 to 2.8. Photofunctionalization resulted in a more frequent use of implants of 10 mm or shorter length and an overall decrease in implant diameter. CONCLUSIONS: Within the limits of this retrospective study, despite the more frequent use of shorter and smaller-diameter implants, the use of photofunctionalization allowed for a faster loading protocol without compromising the success rate. The outcome was associated with an increased rate of implant stability development. The results suggest that photofunctionalization may provide a novel and practical avenue to further advance implant therapy.

A novel combined surgical approach to vertical alveolar ridge augmentation with titanium mesh, resorbable membrane, and rhPDGF-BB: a retrospective consecutive case series.

The purpose of this case series was to report the clinical outcomes and histologic findings of vertical ridge augmentation using a combination of titanium mesh, resorbable collagen membrane, and recombinant human platelet-derived growth factor BB (rhPDGF-BB). Nineteen patients were included, and autogenous bone and anorganic bovine bone particles were used. The bone graft was mixed with rhPDGF-BB and loaded onto the bony defect up to the level of the adjacent alveolar crest. A pre-adapted titanium mesh was placed over the grafted region and covered with a resorbable collagen membrane, leaving no areas of the grafted region exposed. Seventeen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient, whereas the covering collagen membrane was exposed during the later phase of the healing period in another. During reentry surgery for removal of the titanium mesh, three patients with favorable soft and hard tissue healing underwent bone biopsies for histologic evaluation of the augmented tissue just below the titanium mesh. The mean vertical height of augmented bone was 8.6 ± 4.0 mm. This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh, resorbable collagen membrane, and rhPDGF for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely absorbed alveolar ridge.

Three-dimensional bone and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants.

Achieving an esthetic outcome in tooth replacement and implant treatment requires a proper tooth shape and stable surrounding soft tissue profiles. Bone augmentation is considered vital to support the esthetic soft tissue profile around definitive restorations. To prevent recession of the peri-implant soft tissue in cases with multiple implants, buccal bone augmentation of more than 2 mm from the implant platform is necessary to overcome the normal pattern of bone remodeling. Drawing an imaginary horizontal line spanning the space between the remaining healthy interproximal bone peaks is the most reliable vertical augmentation target to create esthetic papillae around an implant prosthesis. Provided that the adjacent bone peaks are at an ideal height and the bone is augmented vertically up to this line, the accepted general guideline of 2 to 3 mm of interproximal vertical bone augmentation from ideally placed implant platforms will invariably also be achieved. In addition, placing pontics in strategic positions to avoid consecutively placed implants has been suggested to facilitate vertical bone height preservation after bone augmentation. Even with esthetically successful results, there have been very few long-term studies on compromised cases with multiple implants. This will become more and more critical over time and must be remedied.

Advantages of the root submergence technique for pontic site development in esthetic implant therapy.

A single-tooth implant in the esthetic region has good potential for success, but it is still challenging to restore multiple-tooth defects with implant-supported prostheses that resemble the natural dentition. This article suggests a strategy to provide a more predictable protocol for esthetic implant treatment for multiple-tooth defects using the root submergence technique (RST). By maintaining the natural tooth root with the RST a much greater amount of surrounding tissue may be preserved than with the commonly used socket preservation technique, which almost always leads to crestal bone resorption and thus reduction of the height of the interdental papillae and width of the edentulous ridge. RST instead maintains the natural attachment apparatus of the tooth in the pontic site, which in turn allows for complete preservation of the alveolar bone frame and assists in the creation of an esthetic result in adjacent multiple-tooth-replacement cases. In situations with periodontal bone loss, orthodontic extrusion is required to create the underlying bone support for the papilla that is necessary to guarantee predictability.

Timing, positioning, and sequential staging in esthetic implant therapy: a four-dimensional perspective.

Many articles address the predictability of immediate implant placement into extraction sockets; however, there are only a few reports that mention the indications and limitations of this technique. The aim of this article is to re-examine specific indications for immediate implant placement and to clarify the timing or "fourth dimension" relative to extraction and implant placement. The expanded concept of four-dimensional implant treatment planning involves the new axis of time, which must be considered along with the traditional spatial or three-dimensional management of implant positioning.