Mandibular fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report.

A patient with a severely atrophic right posterior mandible had three endosseous implants placed in conjunction with transposition of the inferior alveolar nerve. Three weeks following implant placement surgery, the patient experienced a spontaneous fracture of the mandible involving the two anterior implants. The two implants were removed, and the fracture was treated with open reduction and fixation with titanium mesh. The fracture healed, and the posterior implant integrated. This report suggests that the buccolingual and superior-inferior position of the mandibular canal can increase the possibility of mandibular fracture by increasing the size of the buccal cortical plate that is removed to expose the nerve during surgery.

Immediately loaded mandibular implant bar overdenture: a surgical and prosthodontic rationale.

Classical guidelines for osseointegration include a long healing time, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Studies on immediately loaded implant-supported prostheses in completely edentulous patients have been reported, exhibiting high success rates comparable to conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately loaded mandibular implant bar overdenture as well as its clinical rationale.

Maintaining and attenuating periodontal tissues for aesthetic implant placement.

Alveolar ridge resorption and soft tissue recession after tooth extraction inevitably disrupted the harmonious pre-existing periodontal complex, compromising clinicians' ability to recreate successful aesthetic restorations. Although numerous surgical procedures had been advocated for the augmentation of both the alveolar ridge and its soft tissue to ideal contours, questions remain regarding viability and predictability of these procedures. This is especially critical in the maxillary anterior region, where a the condition of the soft tissue complex and its relationship to the implant restoration and its adjacent dentition often determines the implant's success. The described technique of retaining the root remnant and inducing the proliferation of the surrounding tissue in conjunction with immediate implant placement results in the preservation of existing soft and hard tissue, thus minimizing the necessity of grafting procedures and facilitating primary flap closure during implant placement.

Scientific rationale for the surgical and prosthodontic protocol for immediately loaded root form implants in the completely edentulous patient.

This paper discusses a modified surgical and prosthodontic protocol to place implants in the completely edentulous patient. Methods for presurgical, prosthodontic workup, impression transfer technique, provisionalization, and attachment placement are also discussed.

Site development for anterior single implant esthetics: the dentulous site.

An inevitable loss of soft and hard tissue after tooth extraction often results in a compromised site for anterior implant esthetics. Various augmentation techniques have been advocated as corrective procedures, but these techniques are time-consuming and not always predictable. Therefore, the fundamental concept of site development for anterior single implant esthetics in the event of a failing tooth is to preserve the existing gingival and osseous tissue. This article identifies factors that affect tissue changes and describes an integration of surgical and prosthodontic approaches that can optimize the tissue maintenance in the anterior esthetic zone.

Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale.

Maintaining the existing gingival architecture of a failing maxillary anterior tooth is essential in achieving an optimal aesthetic result. Immediate implant placement has been advocated to minimize tissue loss following extraction. The incorporation of a customized temporary abutment and immediate fixed provisionalization facilitates maintenance of the gingival architecture for optimal aesthetics and eliminates the need for a removable provisional prosthesis during the healing phase. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.

Flapless anterior implant surgery: a surgical and prosthodontic rationale.

Full-thickness periosteal flap surgery is often accompanied by potential marginal bone loss and/or soft tissue recession. This is critical, particularly for the single-unit implant-supported restoration in the anterior maxilla, where the harmony of the soft and hard tissue architecture is of paramount importance to the development of natural aesthetics and function. This article demonstrates a flapless implant surgery technique in the anterior maxilla for optimal aesthetic results. The indications and limitations of this procedure are also discussed.

Fabricating a stable record base for completely edentulous patients treated with osseointegrated implants using healing abutments.

A stable record base is essential for accurate interocclusal centric relation records in a completely edentulous patient. In implant prosthodontics, several procedures have been suggested for the fabrication of a stable record base. However, these procedures necessitate removal of the healing abutments during the interocclusal record procedure and the trial denture placement, which makes the procedures tedious and time-consuming. When the implant-prosthesis interface is subgingival, the patient may also experience discomfort during these procedures. This article describes a procedure for fabricating a stable record base that uses the healing abutments, which eliminates the necessity of the healing abutment removal and its consequences. Advantages and disadvantages of this procedure are also discussed.

Clinical complications of osseointegrated implants.

STATEMENT OF PROBLEM: There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. PURPOSE: This article attempted to determine the types of complications that have been reported and to provide data regarding their frequency. METHODS: All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented success/failure data regarding implant treatment were evaluated to determine the types of reported complications and to quantify implant loss as it relates to type of prosthesis, arch, time, implant length, and bone quality. RESULTS: Greater implant loss occurred with overdentures than with other types of prostheses. There was greater loss in the maxilla than mandible with fixed complete dentures and overdentures, whereas little arch difference was noted with fixed partial dentures. Implant loss increased with short implants and poor bone quality. The time of implant loss (preprosthetic vs postprosthetic) varied with type of prosthesis. Surgical complications included neurosensory disturbance, hematoma, mandibular fracture, hemorrhage, and tooth devitalization. Initial and long-term marginal bone changes were identified. Peri-implant soft tissue complications included dehiscence, fistulas, and gingival inflammation/proliferation. Mechanical complications were screw loosening/fracture, implant fractures, framework, resin base and veneering material fractures, opposing prosthesis fractures, and overdenture mechanical retention problems. Some studies also presented phonetic and esthetic complications. CONCLUSIONS: Although the literature presents considerable information on implant complications, variations in study design and reporting procedures limited the available data and therefore precluded proper analysis of certain complications.

Effects of smoking on implant success in grafted maxillary sinuses.

STATEMENT OF THE PROBLEM: Cigarette smoking has been identified as a significant risk factor for dental implant treatment. PURPOSE: This retrospective study evaluated the effect of smoking and the amount of cigarette consumption on the success rates of the implants placed in grafted maxillary sinuses. MATERIAL AND METHODS: Sixty patients (16 smokers and 44 nonsmokers) were evaluated for the effects of smoking on osseointegrated implants placed in 84 grafted maxillary sinuses that contained a total of 228 endosseous root-form implants. Seventy implants were placed in 26 maxillary sinuses in smokers, whereas 158 implants were placed in 58 sinuses in nonsmokers. The number of implant failures and the amount of cigarette consumption were recorded. RESULTS: Of the 228 implants, 205 (89.9%) remained in function, after a mean follow-up period of 41.6 months (2 to 60 months). There was a significantly higher cumulative implant success rate in nonsmokers (82.7%) than in smokers (65.3%) (P =.027). Overall cumulative implant success rate was 76%. There was no correlation between implant failures and the amount of cigarette consumption (P >.99). CONCLUSION: Within the limitations of this study, cigarette smoking appeared to be detrimental to the success of osseointegrated implants in grafted maxillary sinuses regardless of the amount of cigarette consumption.

Clinical methods for evaluating implant framework fit.

STATEMENT OF PROBLEM: Passive fit of implant-supported-prosthesis frameworks has been suggested as a prerequisite for successful long-term osseointegration. However, there are no scientific guidelines as to what is passive fit and how to achieve and measure it. PURPOSE: The purpose of this article is to discuss passive fit and to review the various clinical methods that have been suggested for evaluating implant framework fit.Methods. The dental literature was reviewed to identify the clinical methods that have been used to evaluate implant framework fit. CONCLUSIONS: The suggested levels of passive fit are empirical. Numerous techniques have been advocated to evaluate the prosthesis-implant interface, but none individually provides objective results. It is suggested that clinicians use a combination of the available methods to minimize misfits.