A Prospective Clinical Assessment of BioHorizons Tissue-Level Implants.

This investigation was designed to evaluate crestal bone stability and soft tissue maintenance to Laser-Lok tapered tissue-level implants. Twelve patients presenting with an edentulous site adequate for the placement of two implants were recruited from four dental offices (2 to 4 patients per office). Each patient received two Laser-Lok tissue-level implants placed with a 3-mm interimplant distance according to a surgical stent. The implants were placed so that the Laser-Lok zone sat at the junction between hard and soft tissues. A total of 24 implants were placed, and all achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after receiving the final prosthetic restoration.

Treatment of Teeth with an Insufficient Clinical Crown. Part 2: Treatment Cost and Time and Patient Outcomes.

This study involves a group of 168 teeth in 126 patients treated with crown lengthening and tooth reconstruction (experimental group), and a group of 75 teeth from 62 patients that were judged irrational to treat, extracted, and replaced (control group). In the control group, 13 teeth in 12 patients were not replaced; 37 were replaced with an implant-supported crown, 14 with a tooth-supported partial denture, 2 with a Maryland partial denture; and 9 patients requested a removable prosthesis. In the experimental group, 44 teeth in 37 patients received a conservative restoration (24 direct and 20 indirect), while 124 teeth in 94 patients received a full crown. All 168 teeth were surgically treated with minimally invasive crown lengthening. Endodontic treatment and orthodontic extrusion were applied when necessary. Treatment resulted in healthy periodontal and dental/implant conditions at the 1-year follow-up in both groups. Function and esthetics were described from satisfactory to extremely satisfactory by patients of both groups, with the exception of three patients in the control group who received a mobile prosthesis restoration and reported some difficulties in chewing. When comparing treatment cost and duration of the reconstructed teeth (experimental group) to the treatment cost and duration of extracted and replaced teeth (control group), the difference is significantly in favor of the preservation of natural teeth, both monetarily and in terms treatment time. Saving a tooth with a compromised crown is more favorable for the patient than extraction and replacement. This conservative approach is advisable to clinicians whenever the clinical conditions enable treatment.

Minimally Invasive Management of Implant-Supported Rehabilitation in the Posterior Maxilla, Part II. Surgical Techniques and Decision Tree.

Insufficient crestal bone is a common feature encountered in the edentulous posterior maxilla due to atrophy of the alveolar ridge and maxillary sinus pneumatization. Numerous surgical techniques, grafting materials, and timing protocols have been proposed for implant-supported rehabilitation of posterior maxillae with limited bone height. In the majority of potential implant sites, residual bone height is less than 8 mm and the clinician has to select either a lateral or transcrestal sinus-elevation technique or placing short implants as the correct surgical option. Nevertheless, guidelines for selecting the best option remains mostly based on the personal experience and skills of the surgeon. The role of sinus anatomy in healing and graft remodeling after sinus floor augmentation is crucial. In addition to the evaluation of residual bone height, the clinician should consider that histologic and clinical outcomes are also influenced by the buccal-palatal bone wall distance. Therefore, three main clinical scenarios may be identified and treated with either a lateral or transcrestal sinus-elevation technique or short implants. This article introduces a new decision tree for a minimally invasive approach based on current evidence to help the clinician safely and predictably manage implant-supported treatment of the atrophic posterior maxilla.

A Prospective Clinical and Radiographic Assessment of Platform-Switched Laser-Microchannel Implants Placed in Limited Interimplant Spaces.

This multicenter clinical trial of platform-switched laser-microchannel implants supports findings from a previous preclinical trial. Previous information indicated that an interimplant distance narrower than 3 mm would result in decrease in the crestal bone level, but the results of this investigation suggest that a more optimistic clinical result can be anticipated for implants and abutments with a laser-microchannel surface.

Assessment of Marginal Peri-implant Bone-Level Short-Length Implants Compared with Standard Implants Supporting Single Crowns in a Controlled Clinical Trial: 12-Month Follow-up.

In oral rehabilitation, crown-to-root ratio is accepted as an indicator of bone loss, and this concept was transferred to implants. Recent studies have indicated that there is no significant difference between short and standard implants. The aim of this study was to compare marginal bone-level alteration through radiographic evaluation and clinical parameters between short and standard implants supporting single crowns. This prospective clinical trial study included 82 systemically healthy, nonsmoking subjects. Patients were divided into two groups: one group for short dental implants measuring 5.5 or 7 mm, and one group for standard dental implants measuring 10 or 12 mm, in accordance with the individual needs of the patient. A clinical dental history was taken for each subject, including model casts, dental radiography, and cone beam computed tomography. A periapical analysis was also performed using ImageJ computer software to establish the initial bone measurement and periapical bone loss. A statistically significant difference was found in favor of the standard-length implants after 12 months, with greater gingival recession around the implant; however, bone loss in the short implants did not exceed 0.53 mm. The treatment with 5.5- to 7-mm-length implants is as reliable as treatment with 10- or 12-mm implants. Peri-implant bone loss is minimal, and therefore use of short implants can be recommended as treatment for the restoration of partially edentulous patients without the need for splinted crowns.

Wound Healing of the Laterally Positioned Flap: A Histomorphometric Assessment.

The aim of this study was to histomorphometrically assess the soft tissue anatomy in single gingival recessions (GR) treated with a laterally positioned flap (LPF). Five patients presenting maxillary first molars with GR to the apex of the buccal surface of the mesial-buccal root were invited to take part. The LPF-treated roots were removed en bloc (the root and the soft tissue covering the treated GR) 3 to 4 months postoperatively. Photomicrographs of Mallory trichrome stain sections were taken to allow reassessment of the specimens regarding the longitudinal dimensions of the crevicular/sulcular and junctional epithelia. The use of LPF resulted in new attachment with formation of crevicular epithelium, long junctional epithelium, and some connective tissue, re-establishing the normal anatomical characteristics of the soft tissues covering the previously exposed root.

Human histologic assessment of a platform-switched osseointegrated dental implant.

This case report examined crestal bone level maintenance surrounding a platform-switched implant that was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated tight contact with the surrounding bone and demonstrated both radiographic and histologic features that were indicative of successful osseointegration. Very high bone-to-implant contact (BIC) without epithelial downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and native bone. The buccal and lingual bone levels coincided with the original platform position noted at the time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the maintenance of the crestal bone level for platform-switched implants.