Influence of Implant-Tooth Proximity on Incidence of Caries in Teeth Adjacent to Implants in Molar Sites: A Retrospective Radiographic Analysis of 300 Consecutive Implants.

Implants used to replace molar teeth present issues of space distribution and crown contours that are unique to these sites. Because the diameter of the implant typically is smaller than that of the tooth being replaced, and the circular shape of the implant does not replicate the anatomy of the tooth, a large gingival embrasure area between the implant platform and adjacent tooth often results. Upon the review of radiographs of molar implants placed over an 11-year period in one private practice, the authors identified an unusually high incidence of approximal, cervical, and root caries on teeth adjacent to these implants. This retrospective radiographic study investigated the incidence of decay as related to: (1) the horizontal distance from the implant to the adjacent tooth (ie, the implant-tooth distance, or ITD) as measured at the alveolar crest, (2) the vertical distance from the apical portion of the prosthetic contact area to the implant platform, and (3) the presence of an existing restoration on the adjacent tooth. Of the three variables examined, both the horizontal distance of the implant to a natural tooth (ITD) and the presence of an existing restoration on an adjacent tooth proved to be significantly correlated with the incidence of decay. Results showed that incidence of decay ranges from 7.4% when the ITD is less than 2 mm to 40% when the ITD is ≥6 mm. The mean ITD in cases in which decay was found was 4.1 mm, and it was 3.5 mm in cases that showed no decay (P = .005). It is therefore suggested that the horizontal threshold of 4 mm be considered as the "critical ITD." The results also indicated that the presence of a previous restoration on an adjacent tooth increases the incidence of decay to a statistically significant degree with an odds ratio of 2.25 at a 95% confidence level. This information may prove useful in diagnosis and treatment planning for molar implant replacement.

Influence of Implant-Tooth Proximity on Incidence of Caries in Teeth Adjacent to Implants in Molar Sites: A Retrospective Radiographic Analysis of 300 Consecutive Implants.

Implants used to replace molar teeth present issues of space distribution and crown contours that are unique to these sites. Because the diameter of the implant typically is smaller than that of the tooth being replaced, and the circular shape of the implant does not replicate the anatomy of the tooth, a large gingival embrasure area between the implant platform and adjacent tooth often results. Upon the review of radiographs of molar implants placed over an 11-year period in one private practice, the authors identified an unusually high incidence of approximal, cervical, and root caries on teeth adjacent to these implants. This retrospective radiographic study investigated the incidence of decay as related to: (1) the horizontal distance from the implant to the adjacent tooth (ie, the implant-tooth distance, or ITD) as measured at the alveolar crest, (2) the vertical distance from the apical portion of the prosthetic contact area to the implant platform, and (3) the presence of an existing restoration on the adjacent tooth. Of the three variables examined, both the horizontal distance of the implant to a natural tooth (ITD) and the presence of an existing restoration on an adjacent tooth proved to be significantly correlated with the incidence of decay. Results showed that incidence of decay ranges from 7.4% when the ITD is <2 mm to 40% when the ITD is ≥6 mm. The mean ITD in cases in which decay was found was 4.1 mm, and it was 3.5 mm in cases that showed no decay (P = .005). It is therefore suggested that the horizontal threshold of 4 mm be considered as the "critical ITD." The results also indicated that the presence of a previous restoration on an adjacent tooth increases the incidence of decay to a statistically significant degree with an odds ratio of 2.25 at a 95% confidence level. This information may prove useful in diagnosis and treatment planning for molar implant replacement.

Placement of immediate implants and a fixed provisional restoration to replace the four mandibular incisors.

A new approach to the replacement of four mandibular incisors with localized, chronic, severe periodontitis is proposed in this clinical report. Their replacement with immediately placed implants and a nonocclusally loaded provisional restoration is a simple, predictable, and successful treatment modality. Data from 10 consecutive clinical cases are presented, and a 100% implant survival rate is reported for a 6-year period of follow-up. Treatment outcomes for this approach compare favorably with alternative treatment options and should be considered an important primary treatment option for most patients requiring the replacement of the four mandibular incisors.

Immediate Placement of Dental Implants in Molar Extraction Sockets: An 11-Year Retrospective Analysis.

The authors present an 11-year retrospective analysis of 300 immediately placed implants in molar extraction sockets. The protocol used for the placement and restoration of these implants is based upon a previously published article by the authors regarding the classification of molar extraction sockets. Four different implant systems were used during this study, and implants varied in diameter, length, and texture. Some implants were immediately provisionalized, and some were immediately loaded. The overall survival rate of 97.3% is similar to previously reported survival rates in delayed molar implant placement protocols. The benefits of immediate molar implant placement include a reduced number of surgical procedures and patient visits, lower cost of treatment, and shorter time required from beginning to completion of treatment.

A simplified socket classification and repair technique.

UNLABELLED: Clinicians are often confronted with changes in the anatomy of the local site following tooth extraction. Successful management of the extraction socket can be challenging, particularly in the aesthetic zone. Proper management is necessary to ensure that the implant used to support a prosthesis will remain stable. This article will recommend a classification system for various types of extraction sockets. A simple, noninvasive approach to the grafting and management of sockets when soft tissue is present but the buccal plate is compromised following tooth extraction will also be discussed. LEARNING OBJECTIVES: This article discusses a classification system for extraction sockets and a noninvasive approach for grafting. Upon reading this article, the reader should: Understand the proposed classification system, which addresses three different types of sockets. Become more familiar with the steps involved in a socket-repair technique for Type II sockets.

Classification of molar extraction sites for immediate dental implant placement: technical note.

Dental implants may be successfully placed immediately into fresh extraction sockets when primary implant stability can be attained. This article presents a new classification system for molar extraction sites that describes extraction sockets based upon the bone available within the socket for stabilization of an immediately placed implant. Three categories--types A, B, and C--are employed: the type A socket, which allows for the implant to be placed completely within the septal bone, leaving no gaps between the implant and the socket walls; the type B socket, which has enough septal bone to stabilize but not completely surround the implant, leaving gaps between one or more surfaces of the implant and the socket walls; and the type C socket, which has little to no septal bone, thus requiring that the implant engage the periphery of the socket. Treatment protocols and relevant clinical examples are presented based upon the characterization of the socket according to this classification system.