Peri-implant soft tissue volume changes after microsurgical envelope technique with a connective tissue graft. A 5-year retrospective case series.

AIM: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG). MATERIALS AND METHODS: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns. RESULTS: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm. CONCLUSIONS: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years.

The Complete Digital Workflow in Implant Dentistry.

Current diagnostic and treatment planning tools support a complete digital workflow that takes the guesswork out of implant dentistry and facilitates asynchronous collaboration between all involved specialties, from the restorative dentist to the surgeon to the dental laboratory. Long gone are the days of freehanded implant placement as guided as well as navigated surgery and now even robots provide unprecedented precision and predictability in implant placement based on the individual medical, morphologic, and anatomic situation of each patient.

Effectiveness of Two Differently Processed Bovine-Derived Xenografts for Alveolar Ridge Preservation with a Minimally Invasive Tooth Extraction Approach: A Feasibility Clinical Trial.

Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles).

Implant position and guided placement for in-house-produced CAD/CAM restorations with titanium (Ti)-bases.

Digital dentistry has contributed to the evolution and simplification of dental implantology over the last decade. The incorporation of intraoral scanners, CBCT, 3D implant-planning software, and CAD/CAM systems makes prosthetically driven implantology a straightforward process. Such digital resources for treatment planning and execution, following evidence-based concepts, have the ability to improve the long-term esthetics and function of implant-supported restorations as well the long-term survival of dental implants. Dental implants are frequently considered as the first treatment option for replacing failing or missing teeth. However, their use in the esthetic zone remains a challenge for many clinicians. The present article provides clinical guidelines for ideal implant positioning employing computer-guided surgery and chairside CAD/CAM-fabricated provisional and definitive restorations with titanium (Ti)-bases for successful prosthetic outcomes, optimizing gingival architecture, and decreasing overall treatment duration. (Int J Comput Dent 2023;26(1):75-0; doi: 10.3290/j.ijcd.b3818287).

Digital Implant Planning and Surgical Guides: Tools for Clinical Success.

Digital technologies have fundamentally changed treatment planning, surgical placement, and restoration of dental implants, improving clinical success while saving valuable chairtime. Intraoral scanners (IOS), cone-beam computed tomography (CBCT), 3D implant planning software, and CAD/CAM systems that fabricate surgical guides and provisional and definitive restorations have become standard tools for precise implant placement and ideal restoration design, which are essential for optimal and long-term esthetic and functional success. This article summarizes clinical guidelines for integration of digital technologies in implant dentistry.

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach.

Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue-implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant-soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.

Virtual implant planning in the edentulous maxilla: criteria for decision making of prosthesis design.

OBJECTIVES: To evaluate prosthetic parameters in the edentulous anterior maxilla for decision making between fixed and removable implant prosthesis using virtual planning software. MATERIAL AND METHODS: CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Implants (≥3.5 mm diameter, ≥10 mm length) were virtually placed in the optimal three-dimensional prosthetic position of all maxillary front teeth. Anatomical and prosthetic landmarks, including the cervical crown point (C-Point), the acrylic flange border (F-Point), and the implant-platform buccal-end (I-Point) were defined in each middle section to determine four measuring parameters: (1) acrylic flange height (FLHeight), (2) mucosal coverage (MucCov), (3) crown-Implant distance (CID) and (4) buccal prosthesis profile (ProsthProfile). Based on these parameters, all patients were assigned to one of three classes: (A) MucCov ≤ 0 mm and ProsthProfile≥45(0) allowing for fixed prosthesis, (B) MucCov = 0-5 mm and/or ProsthProfile = 30(0) -45(0) probably allowing for fixed prosthesis, and (C) MucCov ≥ 5 mm and/or ProsthProfile ≤ 30(0) where removable prosthesis is favorable. Statistical analyses included descriptive methods and non-parametric tests. RESULTS: Mean values were for FLHeight 10.0 mm, MucCov 5.6 mm, CID 7.4 mm, and ProsthProfile 39.1(0) . Seventy percent of patients fulfilled class C criteria (removable), 21% class B (probably fixed), and 2% class A (fixed), while in 7% (three patients) bone volume was insufficient for implant planning. CONCLUSIONS: The proposed classification and virtual planning procedure simplify the decision-making process regarding type of prosthesis and increase predictability of esthetic treatment outcomes. It was demonstrated that in the majority of cases, the space between the prosthetic crown and implant platform had to be filled with prosthetic materials.

Prosthetic considerations for orthodontic implant site development in the adult patient.

Proper site development is a key factor for long-term clinical success of dental implants. Whereas surgical and restorative techniques have been refined to ensure predictable functional and esthetic outcome, individual clinical prerequisites do not always allow proper placement of implants when prosthetic and material properties are considered. Orthodontic tooth movement may be a viable and nonsurgical site development treatment option. With the introduction and advancements of minimal invasive and less visible orthodontic appliances, a growing number of adult patients are willing to obtain orthodontic treatment. The spectrum of modern appliances is broad and ranges from clear aligners to lingual brackets. Skeletal anchorage devices such as orthodontic mini-implants often eliminate unpopular external anchorage devices (ie, headgear) in adult patients, This article discusses the selection of an appropriate pretreatment approach by taking patient-specific criteria into account.

Zirconia abutments for single-tooth implants--rationale and clinical guidelines.

Clinical success of an endosseous implant to replace a single tooth is not only defined by its survival. Esthetic parameters have become integral aspects in defining success and failure. All-ceramic abutments have started to play a major role in achieving an esthetically successful result. The material itself, however, is not the exclusive determinant for esthetic success. It is the appropriate design and proper handling of the material and the abutment that enables the clinician to achieve esthetic outcomes that were not possible with traditional metal alloys. This article explores the rationale for using zirconia for prosthetic implant components, explains specific material properties, and discusses strategies and guidelines for the design and successful clinical implementation of CAD/CAM-fabricated zirconia implant abutments.

A modified layering technique to enhance fluorescence in glass-infiltrated aluminum oxide ceramic restorations: case report.

Fluorescence, opalescence, and translucency are critical for restorative materials to mimic the optical properties and appearance of natural teeth. This case report describes the restoration of multiple anterior teeth with CAD/CAM-fabricated glass-infiltrated aluminum oxide ceramic (In-Ceram Alumina, Vita Zahnfabrik) crowns and illustrates the technical steps to achieve an adequate amount of fluorescence in the ceramic veneering material. CAD/CAM aluminum oxide ceramic copings and frameworks can be predictable and successful when replacing missing tooth structure and imitating optical properties of natural teeth. A modified layering technique enhances fluorescence within the veneering ceramic and provides an esthetic appearance of glass-infiltrated aluminum oxide ceramic restorations.

CAD/CAM and telescopic technology: design options for implant-supported overdentures.

There are many options with respect to materials, construction methods, and design concepts for the technical implementation of implant-supported dental prostheses. Different methods of anchorage can be used to attach removable superstructures to implants. Telescopic crowns make it possible to fabricate inexpensive superstructures with precise and passive fit. Computer-aided design/computer-assisted manufacture (CAD/CAM) technology allows copings to be fabricated from materials such as zirconia or titanium. Moreover, CAD/CAM crown copings can serve as a base for fabricating customized ceramic replacement teeth. Different veneering techniques, such as pressed-on ceramics for zirconia cores, ensure a fast and economic work process. With the use of electroforming it is possible to manufacture highly precise secondary structures that ensure passive seating of the prosthesis in a stable position. This article demonstrates a restorative treatment option using current techniques with the aim of rehabilitation with an esthetic and functional implant-supported removable denture.

Precision for computer-guided implant placement: using 3D planning software and fixed intraoral reference points.

PURPOSE: The aim of this article is to describe the application of screws as fixed intraoral reference points for stable, precise, and repeatable positioning of diagnostic and surgical templates for implant placement. MATERIALS AND METHODS: Currently available software programs in combination with computed tomography data allow 3-dimensional treatment planning in demanding clinical situations prior to implant placement. One drawback of most systems is the lack of stability and support of both radiographic and surgical templates in edentulous patients. The characteristics and application of a new screw system in combination with computer assisted 3-dimensional implant placement are specified. RESULTS: Implants were placed exactly as projected without impairment of the mandibular nerve despite close proximity of the mental foramen. CONCLUSION: Precision and accuracy of computer-based or -supported implant placement is valuable only if an exact transfer to the intraoral situation is granted. Depending on the clinical patient situation, fixed intraoral reference points can improve precision in an efficient manner.

Prosthodontic considerations for predictable single-implant esthetics in the anterior maxilla.

Long-term functional and esthetic success with implant-supported single-tooth restorations requires a comprehensive and interdisciplinary treatment approach. Important parameters include the initial clinical situation, the surgical approach, the provisional phase, and the choice of abutment material and design as well as the definitive restoration. This article presents the main aspects of current treatment protocols and discusses material options and clinical techniques to achieve predictable outcomes.

Immediate loading of dental implants in the edentulous mandible.

BACKGROUND: The authors review the literature regarding immediate implant loading in the anterior edentulous mandible, demonstrate the technique they currently use, review preliminary results and present an illustrative case. MATERIALS AND METHODS: The authors conducted a literature search using PUBMED and Ovid databases. They considered for review 31 articles in English from 1969 to 2003 that pertained to immediate loading of the anterior mandible. The authors developed a technique to provide a bar-supported prosthesis on the day of surgery. They treated five patients and followed them up for at least six months. The preliminary results are presented. RESULTS: This literature review demonstrated that immediate loading of anterior mandibular implants is an acceptable method, with predictable results. This case series demonstrates the potential for delivering a final bar on the day of surgery, based on the current evidence and clinical application. CONCLUSIONS AND PRACTICE IMPLICATIONS: The method described provides patients with immediate prosthetic restorations and a decreased treatment time compared with that for the traditional two-stage implant approach.

Single-implant restorations: a contemporary approach for achieving a predictable outcome.

The replacement and restoration of missing single teeth with dental implants are routine procedures. However, because of the relatively short clinical history of this procedure in dentistry, custom-tailored protocols for this procedure do not exist. This article will outline the various surgical and restorative steps involved in the treatment planning, fabrication, and delivery of single-implant restoration, and will critically analyze the existing clinical concepts and provide recommendations based on a contemporary approach. As data for and experience with this procedure increase the same general guidelines for all types of implant restorations may not apply. Emphasis will be placed on differentiating between the various types of single-implant restorations, comparing and contrasting the differences between the different types of single-implant restorations, and revising some of the existing concepts of this treatment modality.

Long-term resin bond to densely sintered aluminum oxide ceramic.

BACKGROUND: Densely sintered aluminium oxide ceramic is a popular material for ceramic copings and all-ceramic restorations. A strong, predictable, and long-term durable resin bond is key for long-term clinical success of bonded alumina-based restorations. PURPOSE: The purpose of this study was to measure and compare in vitro shear bond strengths of three resin cements with and without their corresponding silane coupling/bonding agent to air particle- abraded densely sintered aluminum oxide ceramic after long-term water storage and thermocycling. MATERIALS AND METHODS: Composite resin cylinders were bonded to air particle-abraded samples of densely sintered aluminum oxide ceramic with Noribond DC (Noritake Dental Supply, Inc., Aichi, Japan), Panavia 21 EX (Kuraray, Osaka, Japan), and Variolink II (Ivoclar Vivadent, Schaan, Liechtenstein), which were used with and without their corresponding silane coupling and bonding agents (n = 15). All specimens (N = 90) were stored for 180 days in water and subjected to repeated thermocycling for a total of 12,000 cycles before shear bond strength was tested. Data were analyzed with the Kruskal-Wallis test and the Wilcoxon two-sample rank sum test at the 5% level of significance. RESULTS: Most groups had no or only minimal bond strength to densely sintered alumina after simulated aging. Panavia had the highest bond strength without silane/bonding agent application. Noribond with its silane/bonding agent revealed the highest overall bond strength, which was significantly greater than that of either Variolink or Panavia after silanization. CONCLUSIONS: Resin cements revealed significantly different bond strengths, and the use of silane coupling and bonding agents had various effects on the resin bond to pure densely sintered alumina. CLINICAL SIGNIFICANCE: Selection of the proper cement/bonding system is fundamental to clinical long-term success of bonded alumina-based restorations. Noribond with its bonding agent and ceramic primer seem to fulfill these requirements under clinically relevant testing conditions.