Utilization of Low-Magnitude High-Frequency Vibration (LMHFV) as an Aid in Treating Peri-Implantitis: Case Presentations.

Peri-implantitis is an inflammatory process initiating in the soft tissue and then progressing to the hard tissue surrounding dental implants leading to loss of osseous support and potential loss of the implant if not identified early in the process. This process initiates in the soft tissue, which become inflamed spreading to the underlying bone leading to decreases in bone density with subsequent crestal resorption and thread exposure. In the absence of treatment of the peri-implantitis, the bone loss at the osseous implant interface progresses with inflammatory mediated decrease in the bone density that moves apically, eventually leading to mobility of the implant and its failure. Low-magnitude high-frequency vibration (LMHFV) has been shown to improve bone density, stimulate osteoblastic activity, and arrest progression of peri-implantitis with improvement of the bone or graft around the affected implant with or without surgery as part of the treatment. Two cases are presented using LMHFV to augment treatment.

Horizontal Ridge Augmentation Under a Removable Partial Denture and Implant Placement.

Implant planning has moved in recent years to virtual planning with a CBCT scan and fabrication of a surgical guide based on that virtual planning. Unfortunately, positioning based on prosthetics is typically missing from the CBCT scan. Use of a diagnostic guide fabricated in office permits information from ideal prosthetic positioning to improve virtual planning and subsequent fabricated of a corrected surgical guide. This becomes more important when insufficiencies in the ridges horizontal aspects (width) will require ridge augmentation to allow later implant placement. This article discusses a case with insufficient ridge width and determination of where augmentation is required to house implants in ideal prosthetic positions, the subsequent grafting, implant placement and restoration.

Utilization of Biphasic Calcium Sulfate as Socket Preservation Grafting as a Prelude to Implant Placement: A Case Report.

Extraction of the natural tooth may be a prelude to implant placement. This may be done using an immediate placement protocol or require a delayed approach depending on multiple factors that include residual infection related to the failed tooth being extracted, availability of bone to stabilize the implant at placement, or soft tissue issues. Socket preservation is recommended when the delayed approach is selected to create an osseous bed with adequate height and width that can accommodate the implant that is planned.

Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years.

When natural teeth fail, frequently there is a loss of hard and soft tissue. This may complicate subsequent dental implant placement by creating insufficient bone to house the implant. This also occurs when the tooth has been missing for an extended period, especially in the premaxilla, where the bone is less dense and often lacks sufficient volume of facial bone. Site reconstruction to accommodate implant placement often requires both hard and soft tissue augmentation. The modified interpositional vascularized augmentation neogenesis (mIVAN) technique achieves the desired treatment goals in both delayed and immediate placement scenarios. The technique will be discussed as well as the long-term follow-up on 20 cases.

Biphasic Calcium Sulfate as an Alternative Grafting Material in Various Dental Applications.

Various grafting materials have been used in oral and periodontal surgeries to augment and rebuild bone intraorally. Calcium sulfate, a synthetic material, also known as an alloplast, has been used for decades in orthopedics, plastic surgery, and oncologic and maxillofacial surgeries for the treatment of osseous deficiencies caused by trauma or inflammation. Biphasic calcium sulfate provides benefits as a short-term space maintainer. Use of biphasic calcium sulfate as the sole material are limited to relatively small osseous defects surrounded by at least 3 bony walls (eg, extraction sockets). Thus, for augmenting large and more complex bone deficiencies Bond Apatite, a composite graft formulation, is indicated. This work will review the various clinical applications of Bond Apatite as an alternative to other graft materials.

Feline Dental Implants: Long-Term Follow-up of Two Cases.

Dental implants have become an option for replacement of lost canine teeth in cats. Although cats appear to manage well after a canine extraction, complications such as lip entrapment can occur after maxillary canine tooth extraction. Even cats with a complicated crown fracture of the maxillary canine tooth that have had root canal therapy can develop lip entrapment. This can lead to painful lip ulcers and potential need for further dental treatment. Canine tooth replacement with a dental implant and prosthodontic crown is, in the authors' experience, a predictable option that can be offered to clients who would like to replace a lost canine tooth. This report will discuss 2 long-term cases of maxillary canines replaced by dental implants/crowns.

Abdominal scar endometriosis: case report.

Abdominal scar endometriosis, corresponding to the presence of an endometrial tissue near or inside an abdominal surgical incision, is a rare clinical event that can occur in women after gynecological or obstetric surgery. Generally, a triad consisting of underlying mass at the incision, cyclic menstrual scar pain, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical and the differential diagnosis with incarcerated incisional hernia, granuloma, abscess or other soft tissue tumors can be difficult. The authors describe the case of 39-year-old woman who underwent three previous cesarean sections, with a 20-week history of underlying palpable mass at the Pfannenstiel incision, associated to continuous pain. In this case, a surgical excision followed by the histology definitely clarified the diagnosis.

Dental Implants and Incisor Bridge Placement in a Dog.

Veterinary dentistry has tended to follow the trends and advancements in the human dental field. As for any procedure performed on a patient, whether human or animal, an informed decision is based on the available evidence regarding treatment options. This is certainly true for the more involved treatments in veterinary dentistry which can include the disciplines of endodontics and dental implantology. A number of published case reports have been accepted by the specialty that endodontic therapy is indeed a predictable and a valuable service that can be offered to pet owners. Oral implantology has become an accepted and predictable procedure in the human dental field and can now be offered to pet owners if performed by suitable trained veterinary clinicians. The success rate for endosseous implant osseointegration is very high in humans. Success rates are also very high in animals used for implantology research. Canine studies have shown good bone-to-implant contact of around 73% in osseointegrated endosseous implants based on histological sections. Radiographic and histological findings demonstrate stable alveolar crestal bone levels after loading endosseous implants for up to 12 months in a dog model. This article discusses use of dental implants in the rostral mandible of a companion dog to replace periodontally diseased incisors, their restoration, to return the animal to full dental function and 3-year follow-up.

Evolution of Comprehensive Care, Part 3. Periodontal Treatment Continues to Evolve.

Perio treatment has evolved beyond simple scaling with hand instruments. Ultrasonics and diode lasers have improved both the efficiency of treatment as well as treatment prognosis to arresting the disease process and gaining clinical attachment and decreasing pocket depth. Add to this the benefits of adjunct medicaments both at time of treatment via site placement and during routine home care by the patient, and we are able to tip treatment outcome in a more favorable direction. Periodontology has been closely linked to systemic health both as a causative agent to health issues and as a secondary site for some medical conditions. Dentistry has truly--and finally--become a part of total healthcare.

Improving the Prognosis of Periodontally Involved Teeth at the Time of Extraction of Adjacent Teeth With an Amnion-Chorion Barrier and Bioactive Dentin Graft.

With increased awareness, both in the dental literature and by the general public, of peri-implant disease, a growing trend in dentistry is to save teeth with a "questionable" periodontal prognosis. This prospective study involving such patients was designed to evaluate the effects of combining a bioactive barrier and graft, not on the socket but to augment adjacent periodontal conditions on teeth with severe periodontal bone loss at the time of extraction of an adjacent tooth. Fifteen patients were selected; teeth were extracted, ground, prepared with a pH 11 cleanser, partially demineralized, and made into a graft. This mixture was used to augment socket volume and perform periodontal regenerative surgery. The graft was covered with a bioactive amnion-chorion barrier membrane. Bioactive membranes can stimulate host cells in the surrounding gingival and periosteal tissues to accelerate site closure and healing, simultaneously exerting positive effects on the underlying bone and graft material not observed to the same extent with other membranes. This can improve healing and site regeneration as shown clinically and radiographically in this report. Use of these bioactive barrier membrane and dentin graft materials may have additive effects and provide stimulus for conversion to host bone after site healing. The combination of an amnion-chorion membrane with autologous dentin graft appears to maximize the benefits of the individual materials, improving guided tissue regeneration results and the prognoses of periodontally involved teeth.

Implant Placement When an Impacted Tooth and Supernumerary Teeth Are Present in the Maxilla.

The presence of impacted and/or supernumerary teeth in the maxillary anterior region can cause complications when attempting to perform restorations with implants. Extracting these structures can lead to adverse issues related to the adjacent dentition and require osseous grafting to provide a base to house the planned implant, but such an approach increases treatment time and cost. In this case report, a patient presented with an impacted permanent canine oriented on the horizontal plane with several supernumerary teeth coronal to the impacted canine. CBCT analysis revealed a very thin buccal plate over the impacted supernumerary teeth. The proposed treatment followed the principles of partial extraction therapy (PET) whereby the impacted structures were treated like bone, and implants were placed in contact with them or through them to achieve the desired osseointegration and provide long-term survival of the restored implants.

A Review of Sinus Floor Elevation Techniques: Lateral Window, Transcrestal, Graft Materials, and Biologics.

Various approaches to implant placement in the atrophic posterior maxilla are currently advocated in the literature. Such strategies range from the use of block bone graft, to short, tilted, and zygomatic implants, to sinus floor elevation (SFE). SFE has shown to be a predictable surgical procedure to increase bone height in the posterior maxilla. This article provides a narrative overview of SFE techniques, including a modified localized management of sinus floor technique in fresh molar extraction sockets.

Effectiveness of Oral Rinse as an Adjunct to Toothbrushing: A 6-Week Clinical Trial Management of Plaque and Gingivitis With Daily Oral Rinsing.

A common condition found in many patients, gingival inflammation results from irritation from dental plaque and the bacteria contained in plaque. Although effective management of dental plaque and the resulting gingivitis through daily homecare continues to be heavily emphasized, the high prevalence of oral diseases globally suggests that most individuals do not achieve sufficient plaque removal with their manual toothbrushing routine. To help enhance a patient's homecare regimen, daily oral rinsing has been shown to improve oral hygiene. The simple use of mouthwash after toothbrushing optimizes plaque removal while leading to an improvement in gingival health. This article reviews a single-center, randomized, controlled, single-blind, 6-week study designed to evaluate the safety and efficacy of a professional chlorhexidine alternative oral care mouthrinse as an adjunct to toothbrushing with sodium fluoride toothpaste with regard to plaque removal and gingivitis reduction.

Nyctiphanes couchii as intermediate host for Rhadinorhynchus sp. (Acanthocephala, Echinorhynchidae) from NW Iberian Peninsula waters.

In the mesozooplanktonic community of the coastal upwelling system of the Ría de Vigo (NW Spain), the euphausiid Nyctiphanes couchii has been identified for the first time in temperate waters of the NE Atlantic as the intermediate host for cystacanths of Rhadinorhynchus sp. Parasites were identified using morphological characters described in 20 cystacanths. The hooks of the proboscis were arranged in 14 rows of 26 hooks each, while the hooks of the basal circle were only slightly erected and were longer than remaining spines. A maximum-likelihood estimation (ML) tree inferred from the 18S rRNA data set of Palaeacantocephala revealed that our specimens belong to a highly supported clade with Rhadinorhynchus sp., Pararhadinorhynchus sp. and Transvena annulospinosa. Nonetheless, our morphological and phylogenetic analyses suggested that the status of Rhadinorhynchus pristis should be re-examined. The prevalences of parasites were 0.0019% and 0.0001% for frontal and coastal summer communities, and 0.0068% and 0.0008% for coastal and oceanic autumn communities, respectively. The presence of these cystacanths in different mesozooplankton communities throughout the study suggests that the recruitment of parasites may be affected by the oceanography.

Digital Workflow as an Aid to Complex Multidiscipline Dental Treatment for Improved Esthetics.

Complex treatment frequently requires the often challenging task of cohesively melding multiple disciplines of dentistry. The use of a digital workflow aids in simplifying the flow of treatment from start to finish and can result in faster and better outcomes for the patient as compared to traditional analog methods. Digital workflows allow the clinician to design esthetic outcomes and occlusion first virtually, communicate these esthetic designs to the patient, and then transmit digital files to chairside milling and printing devices as well as to dental laboratories for permanent restoration fabrication. In the case presented-a complex implant case in which multiple areas of dental care were incorporated to achieve the patient's desired esthetic goals-the benefits of a digital workflow, including efficient soft-tissue management and streamlined fabrication of custom abutments, are demonstrated.

Peri-implantitis and the Effect of the Implant Surface at Placement.

Modern root-form endosseous dental implants have been used to successfully replace missing teeth for more than four decades. The implant industry has grown substantially during this time, with many hundreds of dental implant manufacturers providing components for clinicians around the globe. Increased acceptance of dental implants has greatly amplified the number of dental implants placed worldwide. As the dental implant patient population continues to age, long-term follow-up after implant placement has become increasingly important due to various factors associated with the condition and maintenance of implants placed. Although dental implants exhibit a high success rate as a medical device, their life expectancy may be limited depending on the patient's changing health, use of medications, lifestyle changes, nutrition, occlusal/bite issues, loss of additional teeth, experiences of trauma, lack of sufficient keratinized soft tissue, loss of bony support, and oral hygiene habits. When loss of soft-tissue coverage and/or bone occurs, the resultant inflammation surrounding the implant is known as peri-implantitis.

Treatment of an ossifying fibroma of the mandible with endodontic microsurgery and grafting with a biphasic calcium sulfate material: a case report.

A significant percentage of lesions of endodontic origin require surgical management due to the possible diagnosis of odontogenic cysts and tumors in the maxilla and mandible. Ossifying fibroma is a benign fibro-osseous lesion that typically presents as a painless, slow-growing, and expansile lesion that appears as a well-demarcated lesion with a variable degree of internal calcification on radiography. Treatment results in a large osseous defect, utilization of a graft to fill the void accelerates healing and prevents complications that may result from failure to fill by the host response. Case presentation: Following endodontic surgery placement of osseous graft material via Guided Tissue Regeneration to fill the defect aids to accelerate fill of the defect on a healthy 26-year-old female patient. A case discussing the one-step treatment of an ossifying fibroma of the anterior part of the mandible following endodontic microsurgery with associated retrograde fill of the apex, then site grating with biphasic calcium sulfate (Bond Apatite®) used in regeneration of the osseous defect related to the lesion and resulting surgery. Clinical discussion: Histologically, the ossifying fibroma is dominated by connective tissue containing cell rich areas with a few fragments of fibrosis. Moreover, in the connective tissue numerous small fragments of spongy and compact bone with areas of partial necrosis present and a significant number of inflammatory cells are observed. Surgical removal of the cyst with thorough curettage of the osseous walls and grafting of the defect provides predictable healing and the desired clinical results sought. Utilization of the biphasic calcium sulfate graft material allows the elimination of the need to overlay the area with a membrane before the flap due to its hard set and the prevention of soft tissue ingrowth into the graft material during the healing phase. Additionally, the hard set of the material allows tenting of the area to maintain the desired volume and ridge contour. Conversion of the graft material depending on the volume placed to host bone occurs over a 3-6 month period. Conclusion: The case report presented, as well as the authors experience mimics the literature on biphasic calcium sulfate in its use as an osseous graft material and is an effective method for the repair of osseous defects that result from the removal of tumors and cysts of the maxilla and mandible. Treatment of an ossifying fibroma is an ideal application of the use of this biphasic calcium sulfate material allowing tenting of the surgical site over the defect created after cyst removal without the need for resorbable collagen membranes. This simplifies its use and decreases material costs that may hamper patient acceptance of treatment without a decrease in expected clinical results.

Case report: utilization of Z-Point fixture "Trans-nasal" implants.

Severe bone loss in the anterior maxilla poses challenges to implant placement, especially when treating the entire arch. Utilization of zygomatic implants may not allow positioning of the implant platform anterior enough to properly support the full arch prosthesis, leaving an anterior cantilever in some clinical cases. Importance: Placement of implants into the trans-nasal bone between the pneumatized maxillary sinus and nasal fossa allows utilization of an extralong implant in this residual bone to augment zygomatic implants placed distal to this for better support of a full arch prosthesis. Case presentation: A typical case is presented with insufficient alveolar height for traditional implant placement in the anterior maxilla following extraction of the dentition related to bone loss resulting from periodontal disease. Review of the anatomy and technique for placement of implants into the Z-point area for trans-nasal implants. Clinical discussion: This article discusses the utilization of trans-nasal implants into the Z-point and the technique for placement in this residual bone with a case example. Conclusions: The Z-point implant aids in the elimination of the anterior cantilever that may be present due to the most anterior the platform for the zygomatic implant can be placed. Trans-nasal implants should be considered as part of the treatment plan in severely resorbed maxillary arches to allow better implant to spread and load management during functioning.

Sinus Augmentation for Implant Placement Utilizing a Novel Synthetic Graft Material with Delayed Immediate Socket Grafting: A 2-Year Case Study.

Frequently, sinus augmentation is required when replacing failing or missing molars in the maxilla due to loss of alveolar bone related to periodontal disease, pneumatization of the sinus or a combination of the two factors. Various materials have been advocated and utilized; these fall into the categories of allograft, xenograft and synthetic materials. This article shall discuss a study of 10 cases with a 2-year follow-up utilizing a novel synthetic graft material used for sinus augmentation either simultaneously with implant placement or in preparation for sinus augmentation and implant placement in the posterior maxilla. The results of the 10 cases in the study found consistent results over the 2-year study period with maintenance of the alveolar height at the maxillary sinus. A lack of complications or failures in the study group demonstrates the technique has useful applications in increasing ridge height to permit implant placement inferior to the sinus floor.