CBCT analysis of mandibular incisor area and feasibility of immediate implant placement. An alveolar housing study.

BACKGROUND: Immediate implant placement (IIP) has shown predictable outcomes when specific requirements are met. The aim of the present study was to radiographically evaluate the dimensions of mandibular incisors and the alveolar bone to further determine the feasibility of IIP in this area. MATERIALS AND METHODS: A total of 404 intact mandibular incisor CBCT images from 101 patients (42 males, 59 females; mean age 49 ± 16.84 years) were analyzed. The mesiodistal tooth width and the distance between the incisal edge (IE), cementoenamel junction (CEJ), facial bone crest (BC), root apex (RA), and fenestration point (F) were registered, together with the alveolar bone width at 1 and 3 mm below BC. Finally, the angular discrepancy between the dental and the alveolar bone long axis (BLA) was recorded as the tooth torque (TT). RESULTS: The CEJ to BC distance was 3.23 ± 1.67 mm. The RA to F mean distance was 15.02 ± 3.97 mm. The mean alveolar bone buccolingual widths at 1 and 3 mm below the facial BC were 7.12 ± 0.82 and 6.32 ± 0.71 mm in the lateral and central incisors, respectively (P 0.001). The buccolingual width was less than 6 mm in more than 33% of the central incisors, but only in 3% of the lateral incisors, displaying increased alveolar width. The average was 165.66 ± 7.47 degrees. CONCLUSIONS: The results presented in this study point toward the need for careful consideration of the requirements for anterior mandibular IIP for success and predictability purposes.

Evaluating Osteogenic Cell Differentiation Efficacy in the Presence of Polylactide Samples With Varied Compositions for Bone Grafting: In Vitro Study.

In oral implantology, surgeons often confront the need to improve alveolar bone quality and volume before implantation in patients with bone defects. Whereas guided bone regeneration with titanium meshes is a clinical gold standard for bone augmentation, mesh removal pre-implantation presents a drawback. This study explores biodegradable scaffolds as an alternative. The research investigates the impact of various compositions of customized bone-grafting scaffolds on proliferation and osteogenic differentiation processes in vitro. Plates (10 × 10 × 0.5 mm) were fabricated from polylactide (PLA), PLA with 15% hydroxyapatite nanoparticles (PLA/HA), and polylactide with glycolic acid copolymers (PLGA 60:40 and 85:15). Gingival fibroblasts assessed the influence of experimental samples on proliferation and osteogenic differentiation in a low-glucose medium. Osteogenic differentiation was induced, and alizarin red staining measured extracellular matrix calcification via spectrophotometry. Active proliferation of gingival fibroblasts occurred along scaffold edges during cultivation. Although cells proliferated with experimental samples, rates were lower than control cells. PLA/HA showed higher alizarin red staining intensity, indicating enhanced matrix calcification. Experimental samples (PLA, PLA/HA, PLGA 85:15, PLGA 60:40) supported cell proliferation at lower rates than control. PLA/HA demonstrated increased matrix calcification. Biodegradable membranes were nontoxic, suggesting potential for bone augmentation.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study.

INTRODUCTION: Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. METHODS: Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ). RESULTS: A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. CONCLUSIONS: Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants. CLINICAL SIGNIFICANCE: This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Facial Mucosal Level Change Following Maxillary Anterior Single Immediate Tooth Replacement in Extraction Sockets With Facial Bone Wall Defects: A 4- to 15-Year Retrospective Study.

An intact extraction socket has been considered a prerequisite for an immediate implant placement and provisionalization (IIPP) procedure. Recent studies, however, have shown successful outcomes when IIPP was performed in sockets with a facial bone wall defect. This retrospective study evaluated the facial implant mucosal stability following IIPP in extraction sockets with a facial bone wall defect in the esthetic zone. The study included 16 cases in 16 patients who received maxillary anterior single IIPP with contour bone graft (C-BG) and contour connective tissue graft (C-CTG) in compromised extraction sockets (V- or U-shaped defect). After a mean follow-up of 6 years, the implant success rate was 100% (16/16). Minimal and non-statistically significant changes were noted in the facial implant mucosal and marginal bone level. Statistically significant changes were observed in facial implant mucosal thickness gain (2.5 mm [1.8 mm to 3.5 mm]) and midfacial bone sounding reduction (6 mm). Within the confines of this study, IIPP with simultaneous C-BG and C-CTG in fresh extraction sockets exhibiting a V- or U-shaped facial bone wall defect can lead to long-term successful outcomes in terms of mucosal stability, contour bone gain, and marginal bone level stability.

Frequency of screw-retained angulated screw channel single crown following immediate implant placement and provisionalization in the esthetic zone: A cone beam computed tomography study.

OBJECTIVE: The purpose of this cone beam computed tomography (CBCT) study was to determine the frequency percentage of screw-retained crown using angulated screw channel (ASC) abutment for single immediate implant placement and provisionalization (IIPP) in the esthetic zone. METHODS: The CBCT images of 200 patients without disease and without metal restorations in maxillary anterior teeth were evaluated. The mid-sagittal-sectional CBCT images of maxillary anterior teeth (#6-#11) were created in an implant planning software, screen-captured, and transferred to a presentation program. Template of tapered implants with diameter of 3.5 mm (for central and lateral incisors) and 4.3 mm (for central incisors and canines) and lengths of 13, 15, and 18 mm were applied to the sagittal images to identify the IIPP cases. To qualify for IIPP, the implant must engage >35% bone with at least 1 mm of surrounding bone and no perforations. The IIPP cases were further divided into straight screw channel (IIPPSSC) abutment or 25-degree angulated screw channel abutment (IIPPASC), based upon its restorability. The frequency percentages of possible IIPP, IIPPSSC, and IIPPASC were reported and compared among all maxillary anterior teeth. RESULTS: A total of 1200 maxillary anterior teeth sagittal images from 200 patients (88 male and 112 female) with a mean age of 51.3 years (range 20-83 years) were evaluated in this study. The overall frequency percentages of IIPP, IIPPSSC, and IIPPASC possibility were 84% (74%-92%), 14% (10%-24%), and 75% (66%-87%), respectively. CONCLUSION: Within the limitations of this CBCT study, 90% of single IIPP in the esthetic zone can be restored with screw-retained crown when utilizing ASC. In addition, the possibility of using a screw-retained restoration following IIPP increases about five times with ASC abutment compared to the SSC abutment.

Complications Associated with Metal Resin Fixed Complete Dentures Based on Implant Distribution.

PURPOSE: To compare prevalence and type of complications associated with metal resin fixed complete dentures based on implant distribution. MATERIALS AND METHODS: This retrospective study included data collected for a period of 12 years for patients treated with maxillary and mandibular implant-supported fixed complete dentures at Loma Linda University School of Dentistry. In total, 223 patient's charts were reviewed which included 100 maxillary and 123 mandibular fixed complete dentures. Implant distribution and prevalence of complications associated with each implant-supported fixed complete denture were documented. Tooth delamination, the most common complication associated with fixed complete dentures, was compared between 2 implant distribution groups in each arch. Covariates including age, sex, opposing arch, cantilever occluding units, and number of implants were evaluated to determine their association with tooth delamination. Data and hypotheses were statistically analyzed using descriptive statistics along with logistic regression model. All tests of hypotheses were considered statistically significant at an alpha level of 0.05. RESULTS: In the maxillary arch, some effect of the prevalence of tooth delamination was seen for the group that had implants placed posterior to canine eminence but it was not statistically significant. Denture tooth delamination had the highest prevalence among complications irrespective of implant distribution. Significant denture tooth delamination was seen for patients with opposing fixed complete dentures in comparison to patients with removable opposing arch prostheses. CONCLUSIONS: Implant distribution is not a significant factor related to metal resin fixed complete dentures. Opposing fixed complete dentures have a significantly higher association with denture tooth delamination.

Facial Gingival Changes With and Without Socket Gap Grafting Following Single Maxillary Anterior Immediate Tooth Replacement: One-Year Results.

This 1-year prospective study evaluated horizontal and vertical facial gingival tissue changes after immediate implant placement and provisionalization (IIPP) with and without bone graft in the implant-socket gap (ISG). During IIPP, 10 patients received bone graft material in the ISG (G group), while the other 10 patients did not (NG group). The implants were evaluated for implant stability quotient (ISQ), modified plaque index (mPI), modified bleeding index (mBI), marginal bone level (MBL), facial gingival level (FGL), and facial gingival profile (FGP) changes. The mean ISQ value at 9-month follow-up was statistically significantly greater than on the day of implant surgery (P < .05). The mPI and mBI scores demonstrated that patients were able to maintain a good level of hygiene. There were no statistically significant differences in the mean MBL changes between the G and NG groups (P > .05). There were statistically significant differences in FGL changes between the G (-0.77 mm) and NG (-1.35 mm) groups (P = .035). There were no statistically significant differences in FGP changes between the G and NG groups (P > .05). However, statistically significant differences were noted in FGP change between the 3-12 and 0-12 month intervals in both groups (P < .05). Within the limitations of this study, although no significant differences were noted in FGP changes between groups, G group experienced significantly less FGL changes than NG group. Bone graft material placement into ISG seems to be advantageous for tissue preservation during IIPP. However, future long-term studies, with larger sample size, are needed to validate the efficacy of such procedure.

Accuracy of 3D Printed Models Created by Two Technologies of Printers with Different Designs of Model Base.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) printed models manufactured using two different printer technologies with different model base designs. MATERIALS AND METHODS: A maxillary typodont was scanned using a desktop scanner to generate the Standard Tessellation Language (STL) file as a reference scan. After the scanning procedure, the STL file was exported to Model Builder™ for designing the following two types of the model bases: a solid base design and a hollow base design with a 2.0 mm thickness of the external shell. Each design was printed to produce 10 models using a Continuous Liquid Interface Production (CLIP) printer and a Digital Light Processing (DLP) printer. The following four groups were tested: CLIP with solid base (CS); CLIP with hollow base (CH); DLP with solid base (DS); and DLP with hollow base (DH). A total of 40 models were scanned using the same desktop scanner to generate the STL files for evaluation of the accuracy by evaluation of trueness and precision. All STL files were superimposed with the control STL file via surface matching software and a comparison was performed using the 3D color mapping function and a 2D comparison of 48 points selected on the tested model. The data were collected by measuring the deviation between the tested model and the reference scan. Trueness was calculated by using the comparison among four tested groups. The Kruskal-Wallis analysis was conducted to assess the overall statistical significance of differences among the tested groups (α = 0.05). For precision measurement, the evaluation was conducted using Intraclass Correlation Coefficient (ICC) value at 95% confident interval to determine the deviation within the same tested groups. RESULTS: The median values for the deviated distance of the four tested groups were 0.045 (CH), 0.035 (CS), 0.077 (DH), and 0.077 mm (DS). There were no statistically significant differences between the trueness of the two groups when using the same printers regardless of the designs of model base (p > 0.05). However, when comparing the two printers using the same model base design and the two different designs of model base, there were statistically significant differences in trueness (p < 0.05). The 3D printed models created using CLIP technology had higher trueness than the DLP technology printer. Precision of the 3D printed model was displayed in ICC value. The ICC values of four tested groups were 0.968 (CH), 0.981 (CS), 0.969 (DH), and 0.983 (DS). All tested groups were classified as exhibiting an excellent level of precision based on 95% confident interval of the ICC estimation. CONCLUSIONS: The accuracy of 3D printed models was affected by the printer technology regardless of whether the model base was solid or hollow. The CLIP technology printer produced significantly less variation from the reference model than the DLP printer. However, all of the 3D printed models were determined to exhibit a clinically acceptable level of accuracy based on the recorded dimensions being less than 100 µm different than the reference model.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

PURPOSE: This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. MATERIAL AND METHODS: Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. RESULTS: A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. CONCLUSION: Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

PURPOSE: This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. MATERIAL AND METHODS: Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. RESULTS: A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. CONCLUSION: Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Long-term Evaluation of Peri-implant Bone Level after Reconstruction of Severely Atrophic Edentulous Maxilla via Vertical and Horizontal Guided Bone Regeneration in Combination with Sinus Augmentation: A Case Series with 1 to 15 Years of Loading.

BACKGROUND: To the best of the authors' knowledge, there is very limited clinical data on the outcomes of simultaneous guided bone regeneration (GBR) for horizontal and/or vertical bone gain for the reconstruction of severely atrophic edentulous maxilla. Therefore, the purpose of the clinical series presented herein was to clinically evaluate long-term horizontal and vertical bone gain, as well as implant survival rate after reconstruction of severely atrophic edentulous maxillary ridges. MATERIAL AND METHODS: Sixteen patients (mean age: 64.6 ± 14.6 years of age) were consecutively treated for vertical and/or horizontal bone augmentation via GBR in combination with bilateral sinus augmentation utilizing a mixture of autologous and anorganic bovine bone. Implant survival, bone gain, intraoperative/postoperative complications and peri-implant bone loss were calculated up to the last follow-up exam. RESULTS: Overall, 122 dental implants were placed into augmented sites and have been followed from 12 to 180 months (mean: 76.5 months). Implant survival was 100% (satisfactory survival rate of 97.5%). Mean bone gain was 5.6 mm (max: 9 mm; min: 3 mm) While vertical bone gain was 5.1 ± 1.8 mm; horizontal bone gain was 7.0 ± 1.5 mm. No intraoperative/postoperative complications were noted. Mean peri-implant bone loss values were consistent within the standards for implant success (1.4 ± 1.0 mm). At patient-level, only one patient who had three implants presented with severe peri-implant bone loss. CONCLUSION: Complete reconstruction of an atrophied maxilla can be successfully achieved by means of guided bone regeneration for horizontal and/or vertical bone gain including bilateral sinus augmentation using a mixture of anorganic bovine bone and autologous bone.

Vertical Bone Grafting and Periosteal Vertical Mattress Suture for the Fixation of Resorbable Membranes and Stabilization of Particulate Grafts in Horizontal Guided Bone Regeneration to Achieve More Predictable Results: A Technical Report.

Osteosynthesis screws and titanium or resorbable pins have been recommended for fixing guided bone regeneration (GBR) membranes and stabilizing the graft. However, the removal of fixation screws or pins often requires an additional surgical procedure. This article presents a periosteal suturing technique with resorbable sutures for the fixation of grafts and membranes in GBR in single implant sites. This technique avoids potential complications of using fixation screws or pins, such as perforation of the roots when inserting the pins, and eliminates the need for a second retrieval surgery.

Treatment of severe mucogingival defects with a combination of strip gingival grafts and a xenogeneic collagen matrix: a prospective case series study.

Large areas of mucogingival alterations may result from advanced regenerative procedures. This prospective case series study was performed to introduce and evaluate a surgical approach that combines the strip gingival graft technique with the use of a xenogeneic collagen matrix. The primary outcome measurement was the increase in keratinized tissue width from baseline to 12 months postprocedure. Twenty patients were enrolled, and they all completed the 12-month evaluation. All treated sites exhibited a significant gain in keratinized tissue at 12 months, with a mean width of 6.33 mm (SD: 2.16), while there was a 43% contraction of the grafted area at 6 months. Tissue dimensions remained stable between 6 and 12 months. The use of the combination graft was well accepted by the patients, with minimal morbidity according to the patients' low self-reported pain and the low utilization of pain medication.

Digitally planned and fabricated mandibular fixed complete dentures. Part 2. Prosthodontic phase.

Part 1 of this patient report described a prosthetically driven protocol that used computer-aided engineering for the fabrication of a mandibular conversion denture and maxillary provisional complete denture using the AvaDent Digital Denture system. The report demonstrated that this system combined with NobelClinician implant-planning software can be used to efficiently convert a digital denture into an immediately loaded provisional implant-supported fixed complete denture (hybrid prosthesis). Part 2 of the patient report describes the technique and steps involved in the fabrication of a digitally planned and fabricated mandibular fixed complete denture with incorporated titanium milled bar opposed by a definitive computer-aided design/computer-assisted manufacture-milled maxillary complete denture.

Marginal bone response of implants with platform switching and non-platform switching abutments in posterior healed sites: a 1-year prospective study.

OBJECTIVES: This 1-year prospective study evaluated the implant success rate and marginal bone response of non-submerged implants with platform and non-platform switching abutments in posterior healed sites. MATERIAL AND METHODS: Nineteen patients (9 male, 10 female) with posterior partially edentulous spaces, between the ages of 23 and 76 (mean = 55.4 years), were included in this study. A total of 30 implants (15 implants restored with platform switching [PS] abutments [control] and 15 implants restored with non-platform switching [NPS] abutments [test]) were assigned between two groups using a randomization procedure. The definitive abutments with conical connections were placed at the time of surgery, and the definitive restorations were placed at 3 months. All patients were evaluated clinically and radiographically using standardized radiographs at time of implant placement (0), 3, 6 and 12 months after implant placement. Data were analyzed using Friedman test with post hoc pairwise comparisons, Mann-Whitney U-test, and Pearson's chi-square test at the significance level of α = 0.05. RESULTS: At 12 months, all 30 implants remained osseointegrated corresponding to a 100% success rate. The overall mean marginal bone level change at 12 months was -0.04 ± 0.08 mm for PS group and -0.19 ± 0.16 mm for NPS group. Statistically significant difference in the marginal bone level change was observed between groups at 0 to 12 months and 3 to 12 months (P < 0.05). CONCLUSIONS: This 1-year randomized control study suggests that when a conical implant-abutment connection is present, similar peri-implant tissue responses can be achieved with platform switching and non-platform switching abutments.

Degree of patient pain, complications, and satisfaction after root canal treatment or a single implant: a preliminary prospective investigation.

INTRODUCTION: Dentists often face the choice between tooth retention with root canal treatment and tooth replacement with implant treatment. To date, there has not been a prospective clinical trial directly comparing nonsurgical root canal treatment and single delayed implant therapy with regard to the degree of preoperative and postoperative pain, complications, and patient satisfaction. METHODS: Twenty-four patients had initial nonsurgical root canal treatment, and another 24 had single implant treatment in healed sites. Questionnaires were given at pretreatment, 7 days, 3 months, 6 months, and 12 months. RESULTS: All patients completed the 12-month follow-up period. No significant difference in pain, complications, or overall satisfaction was noted between the 2 groups at any of the time points (P > .05). However, there were differences within each group between the time points. There was more pain at pretreatment for root canal treatment and 7-day post-treatment point for single implant treatment than any other time point. For complications, more were reported at the 7-day post-treatment point than any other time point for both groups. With overall satisfaction, there was no difference from any time point for either group. CONCLUSIONS: The results of this study suggest that patients perceive both treatments with high degrees of satisfaction with minimal pain and discomfort. Differences were found at different time points of treatment and were related to the nature of the treatment itself. This information is useful to help patients with treatment decisions.

Use of a digitally planned and fabricated mandibular complete denture for easy conversion to an immediately loaded provisional fixed complete denture. Part 1. Planning and surgical phase.

This article describes a unique prosthetically driven protocol that uses computeraided engineering to develop sophisticated, scientific algorithms that guide the fabrication of a conversion denture using the AvaDent Digital Denture system (Global Dental Science). This system is combined with Nobel Clinician (Nobel Biocare) implant-planning software to optimize accuracy and to make it easier and faster to convert a denture to an immediately loaded provisional implant supported fixed complete denture following implant placement, using a NobelGuide surgical template.

Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study.

PURPOSE: This 1-year randomized controlled prospective study evaluated the implant success rate and peri-implant tissue response following single immediate implant placement and provisionalization (IIPP) with and without subepithelial connective tissue graft (SCTG) in the esthetic zone. MATERIALS AND METHODS: Implants were placed either IIPP with SCTG (test group) or IIPP without SCTG (control group). The implants were evaluated both clinically and radiographically before surgery, immediately after implant placement, and 3, 6, and 12 months after implant placement. Data were analyzed using Friedman, Wilcoxon signed-rank, and Mann-Whitney U tests at the significance level of α = .05. RESULTS: Twenty implants (10 test, 10 control) were placed in 20 patients (7 men, 13 women) between the ages of 27 and 87 (mean age, 52.6 years). At 1 year, all implants remained osseointegrated, with overall mean marginal bone changes of -0.01 mm and -0.14 mm for the test and control groups, respectively. Mean facial gingival level change was significantly more pronounced in the control group (-0.70 mm) than in the test group (-0.25 mm). The modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study. At 1 year, the Papilla Index indicated that more than 50% papilla fill was observed in 75% of the test sites and 80% of the control sites. CONCLUSIONS: Within the limitations of this study, SCTG was shown to be beneficial in maintaining facial gingival level when performed in conjunction with IIPP procedures.

Vertical ridge augmentation with titanium-reinforced, dense-PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 19 patients.

PURPOSE: This prospective case series evaluated the use of a new titanium-reinforced nonresorbable membrane (high-density polytetrafluoroethylene), in combination with a mixture of anorganic bovine bone-derived mineral (ABBM) and autogenous particulated bone, for vertical augmentation of deficient alveolar ridges. MATERIALS AND METHODS: A mixture of ABBM and autogenous particulated bone was used for vertical ridge augmentation and covered with a new titanium-reinforced nonresorbable membrane. Ridge measurements were obtained before and after the procedure, complications were recorded, and biopsy specimens were taken for histologic examination. RESULTS: Twenty vertical ridge augmentation procedures were carried out in 19 patients. All treated defect sites exhibited excellent bone formation, with an average bone gain of 5.45 mm (standard deviation 1.93 mm). The healing period was uneventful, and no complications were observed. Eight specimens were examined histologically; on average, autogenous or regenerated bone represented 36.6% of the specimens, ABBM 16.6%, and marrow space 46.8%. No inflammatory responses or foreign-body reactions were noted in the specimens. CONCLUSION: The treatment of vertically deficient alveolar ridges with guided bone regeneration using a mixture of autogenous bone and ABBM and a new titanium-reinforced nonresorbable membrane can be considered successful.