Socket seal surgery combined with immediate implant placement: a novel approach for single-tooth replacement.

Guided bone regeneration procedures around immediately placed implants may result in well-osseointegrated fixtures, but because of complexed flap manipulation, the functional, phonetic, and esthetic result may be unsatisfactory, especially when performed in the maxillary anterior region of the mouth. For better results a modified ridge preservation technique, called "socket seal surgery," which combines bone and soft tissue grafting and is performed prior to implant placement has been suggested. A novel approach is presented in which socket seal surgery is performed simultaneously with implant placement to achieve optimal replacement of an extracted maxillary anterior tooth.

The eversed crestal flap: a surgical modification in endosseous implant procedures.

Successful osseointegration of dental implants largely depends on flap management during implant installation. To obtain optimal biologic conditions for osseointegration, implants and associated bone should be completely covered with soft tissue during the entire healing period. To achieve this, a modified flap design, the eversed crestal flap, is proposed. This technique is aimed at eversion of flap margins by using a combination of vertical mattress and simple sutures to enable tight coaptation of flaps, thus ensuring primary wound closure throughout the healing process.

The use of gingival autografts that contain submucosa in the repair of mucogingival defects in maxillary molars: case reports.

Many studies have shown that deep and wide gingival recessions can be predictably covered by free gingival autografts. Most of the autografts in these studies were performed on single-rooted teeth. This article presents a rationale for a new technique that repairs this type of defect in maxillary molar areas by means of thick masticatory mucosa autografts that intentionally include not only the lamina propria, but also portions of the submucosa. In addition, a new suturing approach that allows adequate adaptation of the donor tissue to the recipient site and permits relocation of the graft is proposed. This new approach has been shown to be a significant advantage in the anatomically problematic maxillary molar area.

Complete flap coverage in augmentation procedures around dental implants using the everted crestal flap.

Guided bone regeneration around exposed parts of dental implants requires the use of membrane barriers that allow only bone forming cells to repopulate the deficient implanted site in the jaw. The membrane should preferably be submerged under the soft tissue during the entire healing process. This provides stabilization of the wound and successful bone regeneration on a predictable basis. The learning objective of this article is to demonstrate the application of the everted crestal flap for guided bone regeneration procedures around dental implants to ensure complete flap coverage over the membrane during the entire healing process.

A modified surgical/prosthetic approach for optimal single implant supported crown. Part I--The socket seal surgery.

Optimal implant placement can be achieved only if the ridge maintains its dimensions and the quality of bone. To prevent the resorption of the ridge and to enhance the quality of regenerated bone, two main approaches have been suggested. Part I of this article presents a modified regenerative technique-the "socket seal surgery" (SSS). Part II will present a modified prosthetic technique--the "cervical contouring concept" (CCC)--and it will be published in the May, 1994, issue of PP&A. The learning objective of this article is to supplement reader knowledge of methods and techniques for prevention of ridge resorption and enhancement of bone regeneration.

A modified surgical/prosthetic approach for an optimal single implant-supported crown. Part II. The cervical contouring concept.

Achieving an aesthetic implant-supported restoration is a constant challenge for the restorative dentist. Part I of this article, published in the March, 1994, issue of PP&A, presented a modified regenerative technique--the "socket seal surgery" (SSS). Part II presents a modified prosthetic technique--the "cervical contouring concept" (CCC). The clinical and laboratory prosthetic procedures are covered in four steps, reshaping of the gingival profile is discussed, and a case report is used to illustrate the procedures. The learning objective of this article is to supplement reader knowledge of methods and techniques in prosthodontic procedures.

Single implant restorations: prosthetically induced soft tissue topography.

An aesthetic transition from the smaller diameter of the implant to the prosthetic restoration that resembles the size of the natural tooth has presented an ongoing challenge to the implant restorative dentists. The appearance of the surrounding soft tissue is of major importance, and various techniques have been developed to guide and optimize its topography. The learning objective of this article is to present a cervical contouring concept, whereby the soft tissue topography is optimally determined already in the laboratory phase. Using a custom abutment and provisional crown as components of the transmucosal prosthetic unit (TPU), the topography is transferred to the vital intraoral tissues, which predictably adapt to the enhanced aesthetic configuration. Clinical cases are presented to demonstrate the sequence of the technique in treating the anterior region of the maxilla.

Implant placement without flaps: a single-stage surgical protocol--Part 1.

Osseointegrated implants have been demonstrated to be predictable, efficacious means of restoring aesthetics and long-term function to edentulous patients. Although the surgical and placement protocols for the use of implant therapy have continued to evolve, specific criteria must be addressed when utilizing this modality. The objective of this article is to describe the requisites for proper implant placement and demonstrate the use of a novel surgical protocol to insert implant fixtures in selected edentulous sites with a mucosal tissue punch rather than a conventional flap elevation procedure.

Implant placement without flaps--Part 2: Utilizing a two-stage surgical protocol.

The single-stage punch technique can provide an effective means of seating an implant fixture without necessitating flap elevation. As described in Part 1 of the article, when the implant must be submerged during the healing phase of osseointegration, the single-stage punch technique may be modified to permit the requisite isolation to be achieved. In this procedure, the mucosal tissue is removed with the soft tissue punch and reseated at the ridge site following the placement of the implant. The second part of the article utilizes two case presentations to demonstrate the proper use of the modified single-stage punch technique.

Reconstruction of function and aesthetics of the maxillary anterior region: a combined periodontal/orthodontic therapy.

Severe cases of periodontal disease often require periodontal surgery. Techniques have been developed attempting to minimize the postsurgical gingival recession and compromise of the interdental papillae. This article presents a case report in which soft tissue regenerative surgery was minimized through combined utilization of periodontal and orthodontic principles. The treatment plan included the control of periodontal inflammation, restoration of lost attachment apparatus, realignment of anterior dentition, and stabilization of occlusion. The anticipated loss of a maxillary central incisor was avoided. The learning objective of this article is to present the advantage of the interdisciplinary form of therapy in such challenging cases.

Treatment classifications and sequencing for postextraction implant therapy: a review.

Dental implantology has become an acceptable and effective treatment modality for totally and partially edentate alveolar arches. When teeth are extracted due to pathology or trauma, bone and soft tissue resorption often occurs. Either an immediate implant placement must be performed or a more traditional treatment plan must be determined; teeth for extraction or incorporation into the overall treatment scheme must also be selected. Selection of the implant site must reflect the mesiodistal, buccolingual, and apicocoronal dimensions. The responsibility of the implant team is to establish a correct diagnosis, evaluate clinical parameters, and design a comprehensive treatment plan, selecting the optimal time for implant placement. The learning objective of this article is to review three classifications of extraction sites and the time sequences of surgical protocols to implant placement following extraction.