A digital protocol for the management of the restorative margin and the emergence profile of vertical prepared teeth.

PURPOSE: To describe a digital workflow for the management of the emergence profile and restoration's finishing line on vertical prepared teeth, utilizing a digital data set. MATERIAL & METHODS: The scan of the prepared teeth the day of the preparation, the scan of the provisional restoration placed on the preparation after soft tissue maturation and the scan of the provisional restoration outside of the oral cavity, are combined under a common data set, that can provide all the necessary information in order to design the final restoration. RESULTS: The presented digital technique can facilitate the implementation of the vertical preparation, as the desired finish line can be defined by the clinician and be transferred predictable to the dental lab. Current approach provides also, an alternative gingival management method, taken advantage of the displacement of soft tissue in the appointment of vertical preparation. CONCLUSIONS: The positioning of the final finishing line on vertical prepared teeth, the management of the soft tissue and the fabrication of the final restoration, can be facilitated combining digital data sets, that have been obtained during a distinct phase of the treatment.

The Influence of Implant Neck Features and Abutment Diameter on Hard and Soft Tissues Around Single Implants Placed in Healed Ridges: Clinical Criteria for Selection.

The clinician's selection of an implant system is influenced by many variables. Ideally, the decision should be based on scientific evidence, but often these decisions are based on economic considerations or influenced by the experience of a trusted peer. The purpose of this paper is to describe the influence of implant neck features (shape and surface) and abutment connection (diameter that matches or is smaller than the implant's platform) on hard and soft tissues around single-tooth implants placed into healed ridges with adequate hard and soft tissue thickness. In an effort to reduce the number of variables, only two-piece implants fully placed at bone level or beneath were taken into consideration. The goal is to provide additional guidance for clinicians on the decision-making and implant-selection processes.

Replacing Hopeless Maxillary Incisors With Adjacent Implants via an Integrative Biologically Oriented Approach.

Achieving successful immediate implant placement in periodontally compromised sites requires that current biologic insights be translated to the modern clinical workflow. The clinical challenge increases in the case of adjacent implants in the smile zone and when the immediately placed implants are to be immediately restored. This article describes and analyzes state-of-the-art concepts and clinical strategies used to maximize key influencing variables to attain success with this treatment modality. These factors that are described in detail include: precise virtual planning for accurate guided implant placement, a flapless surgical approach, bone augmentation and soft-tissue enhancement of the deficient thin biotype, a "one abutment, one time" prosthetic approach for screw-retained restorations utilizing a novel implant system, and model-based cervical design for optimal restorative integration with newly created peri-implant mucosa. The combined digital and analog workflow demonstrates the use of current tools that enable clinicians to predictably perform such treatment in a controlled manner for the right indications.

Effect of age on single implant submersion rate in the central maxillary incisor region: a long-term retrospective study.

BACKGROUND: It is contraindicated to place dental implants before growth and development are completed as they are at a risk of submersion due to growth arrest, creating a potential aesthetic problem. PURPOSE: The present study evaluated the effect of age on mean submersion rate of single dental implant in the central maxillary incisor area as compared with the adjacent natural tooth in implants placed after growth has ceased. MATERIALS AND METHODS: A retrospective study was conducted on 35 patients (mean age 29.3 ± 9.9 years, 21 females) who received a single dental implant replacing a missing maxillary central incisor from 1992 to 2008 with a follow-up of at least 3 years. Clinical photos from last follow-up were digitally analyzed to measure the vertical change between the incisal edge of the implant supported crown and the adjacent natural central incisor. RESULTS: In the younger age group (≤30 years), the submersion rate was more than three times higher than in the older age group (>30 years), yielding submersion rates of 1.02 and 0.27% per year, respectively. CONCLUSIONS: Whereas implant submersion continues throughout adult life, its rate varies with age. It is evident that this phenomenon is much more conspicuous during the second and third decades of life as compared with the fourth and fifth.

Permanent diagnostic provisional restorations for predictable results when redesigning the smile.

In order to determine the optimal method of patient care, the patient's existing clinical condition must be accurately diagnosed and treatment objectives (eg, biocompatibility, aesthetics, long-term function) established accordingly. Once analysis of the condition is complete, the correct restorative procedure can be selected and the complications presented by the patient can be addressed. Comprehensive radiographic and clinical examinations are integral in determining the preoperative status of the patient and, consequently, in evaluating the possibility of actually achieving a successful rehabilitation.

Rotated palatal flaps: A functional and aesthetic solution in endentulous sites.

Resorption of alveolar process generally occurs following tooth extraction, and this process may cause a variety of jaw deformities. Bone deformities in the aesthetic zone impair the appearance, quality, and prognosis of the definitive restoration. The rotated palatal flap is a surgical modality that can be used to reduce or prevent alveolar resorption and assist in the repairing of exisiting defects. This presentation demonstrates the application of the rotated palatal flap in a variety of clinical cases as a means of addressing such resorption.

Restoration modalities of severely injured anterior teeth--gingival integration, papillae support, and predictable imperfections.

This article presents 4 cases, each describing a different dental trauma and a different treatment modality. Because of various limitations, none of the results presented is esthetically perfect, but the outcomes were acceptable to both the operators and the patients. Such limitations should be predicted and discussed with patients before beginning treatment and should be regarded as acceptable compromises, unless other less conservative treatments are to be used.