Role of Keratinized Tissue on the Management of Peri-implantitis: A Case Report.

Peri-implantitis is an inflammatory condition that involves the loss of attachment and support around dental implants. In this case report, a middle-aged woman presented with two implants in the mandibular right quadrant that were diagnosed with peri-implantitis. The patient also had tenderness around the implants and reported sensitivity when performing oral hygiene procedures. Surgical treatment comprised a free gingival graft to augment the keratinized tissue width around the implants, followed by a second procedure of implantoplasty and surface decontamination. The outcome showed radiographic resolution of the peri-implant defect around the premolar implant with a marked increase of keratinized tissue (> 4 mm) around both implants after 1 year of follow up. On a patient level, significantly reduced sensitivity around the implants and better home care were reported. This case report showed that the increase of keratinized tissue may benefit the clinical and patient outcomes of peri-implantitis treatment in terms of decreased probing depths, absence of inflammation, and improved radiographic crestal stability. The combined correction of both hard and soft tissue defects around peri-implantitis lesions may facilitate treatment success and help maintain peri-implant stability.

Managing esthetic implant complications.

Dental implant success today is judged not only by osseointegration but also by esthetic results. Cosmetic predictability can often be difficult to attain, and esthetic implant failures can be multifactorial. Once esthetic implant failures occur, many cannot be fully corrected. Some complications must be addressed by an interdisciplinary dental team. In this summary of case reports, surgical considerations are provided, including cases of facial asymmetry/recession due to facial implant placement or bone loss resulting from technique/treatment failures, as well as papillary deficiencies. Restorative considerations for correcting failures are also discussed.

The subepithelial connective tissue graft with a vestibular releasing incision.

Initially, the rationale for mucogingival surgery was for function and health. In the past few years, esthetic results from augmentation procedures have become a goal. The subepithelial connective graft is a technique to achieve root coverage. Anatomically it is a procedure that cannot be utilized in every case. A difficult situation is the shallow vestibule with no keratinized gingiva and a strong frenulum attachment. The subepithelial connective tissue graft with a vestibular release as described here can achieve esthetic root coverage despite a shallow vestibule.

ITI implant use in private practice: clinical results with 5,526 implants followed up to 72+ months in function.

PURPOSE: To evaluate the success and failure rates over time of ITI implants placed in 3 private practices and used in a variety of clinical situations. MATERIALS AND METHODS: ITI solid-screw implants (n = 5,526) were placed in 3 private practices and restored by a variety of clinicians. Numerous clinical scenarios were treated with the implants, which were in function for between 0 and 72+ months. RESULTS: After 72+ months the cumulative success rates were 94.8% for maxillary implants and 97.5% for mandibular implants. The overall cumulative implant success rate was 96.1%. Implants that failed to osseointegrate were included in the data as failures in the 0- to 12-month interval. The criteria of Albrektsson and associates were used to assess implant success or failure. DISCUSSION: The results, which were achieved in conjunction with numerous restorative clinicians, were comparable to those reported by other authors. The clinical viability of ITI implant use was thus reinforced. CONCLUSION: ITI solid-screw implants were a predictable treatment modality in 3 private practices for a variety of clinical applications.

Masking buccal plate remodeling in the esthetic zone with connective tissue grafts: immediate implant concepts, techniques.

There are many factors to consider concerning immediate implant placement in the esthetic zone, particularly with regard to the biology of remodeling of the anterior maxillary buccal plate. Various techniques have been advocated to minimize alveolar and gingival resorption with immediate implant placement, including the use of particulate grafts in the facial horizontal defect and the use of connective tissue grafts. Full-thickness flaps, split-thickness tunneling, and small subepithelial connective tissue grafts (SCTGs) that are placed coronal to the crest are technique variations that could affect the amount of buccal plate resorption. This case series discusses technique options for autogenous SCTGs with immediate implant placement.