Periodontal, Functional, and Esthetic Integration of Peri-Implant Soft Tissue: WHS Concept.

The long-term functional success of implant treatment depends on the stability of the crestal bone around the implant platform. The esthetic result is achieved by adequate quality and quantity of soft tissue in the peri-implant area. The soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain in the long term, not only implant osseointegration, but also the integrity of the soft tissue around the sub- and suprastructures of the implant restoration. To create the protective soft tissue area, it is necessary to ensure 3 criteria. This treatment approach will be defined as TWS-soft tissue management: T for thickness, W for width, and S for stability. There are many ways to achieve the first 2 criteria, which are described in the literature. Achieving the third criterion of stability has become possible only recently because of the development of digital treatment planning, surgically guided, and prosthetic-assisted technology that uses a 1-time abutment and its implementation into the dental practice. The purpose of this article is to present with clinical cases a detailed description of each criterion.

Smile Management: A Discussion with the Masters.

Smile design is an ongoing challenge in both dentistry and facial cosmetics surgery. Herein, some very common smile design scenarios are shared with six world known masters. Each case will be reviewed by 2 cosmetic dentists, 2 periodontists, and 2 oral and maxillofacial surgeons. At the end, contributors will describe current advances and future prospects of this evolving field.

Anterior Maxillary Growth in Implantology: Complications, Management, and Prevention.

Osseointegrated implantology initially concerned fully edentulous patients, then in time involved partially edentulous patients, and finally, has developed to include patients with single teeth missing on healed ridges and immediate implant placement after extraction. Thus, it was within a normal range of evidence to place implants in adolescents with congenital agenesis or prone to accidents or young adults under 30 after failure of a conservative dental treatment. However, over time the dental profession came to realize that this treatment modality was vulnerable to complications induced by maxillary/mandibular anterior growth with these patients. Although the literature may support the efficacy of osseointegrated implants for fully and partially edentulous patients, care and monitoring must be exercised over at least a 15-year period when treating adolescents with incomplete bone formation with single-tooth replacement.

Soft tissue recession around implants: is it still unavoidable?--Part I.

When treatment with dental implants is indicated, an accurate diagnosis must be made to evaluate the clinical parameters and determine the optimal time for immediate or delayed (ie, early or late) implant placement and loading following tooth extraction. It is also important to identify complications and their implications on the aesthetic outcome. This article explains the behavior of the hard and soft tissue around the implant, evaluates the timing of implant placement after extraction, and reviews various parameters that influence tissue marginal remodeling.

Current trends in gingival recession coverage--Part II: Enamel matrix derivative and platelet-rich plasma.

The recession of the gingiva is increasingly becoming a prominent condition in the oral health of many patients and should be treated at its earliest detection. Part I of this discussion reviewed the multifactorial etiology and decision modality; a treatment option was demonstrated for gingival recession using the tunneling technique. This concluding part of the discussion highlights two clinical cases using alternative approaches. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results.

Current trends in gingival recession coverage--part I: the tunnel connective tissue graft.

The recession of the gingiva is increasingly becoming a more prominent condition in the oral health of many patients and should be treated at its earliest detection. The multifactorial etiology, decision modality, and current trends followed in the treatment of gingival recession are discussed in this presentation. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results. Part II of this discussion will present alternative techniques in treating gingival recession.

Immediate implant placement and temporization in extraction and healing sites.

While single tooth replacement can be predictably accomplished using implant therapy, this procedure is challenging in the esthetic zone where numerous criteria must be evaluated by the restorative team. If the gingival and osseous architecture of the failing tooth is acceptable, the therapeutic goal is to maintain the existing morphological condition. The optimal tridimensional implant is placed in the esthetic zone immediately after extraction or 8 to 12 weeks after extraction. The abutment connection and the nonfunctional temporary tooth restoration are prepared in advance and should respect the forms of contour of the contralateral tooth. In some specific clinical cases, not only can the patient's smile be returned after only a few hours of clinical work, but more importantly, initial capital of soft and hard tissues can be preserved. After healing, maturation, and stabilization during the 3 to 6 months of osseointegration, a compressive impression of the implant site can be taken and the implant restoration can be cemented. A multi-centric study performed by several dentists during the past 3 years have drawn interesting statistics on the rate of success, the different type of implants, and the variation of the peri-implant bone and gingival contour.

Immediate implant placement and temporization: literature review and case studies.

Today, patients are extremely concerned with esthetics. In fact, esthetic demands and expectations are becoming greater everyday. The clinician must address various treatment modalities, focusing on the patient's needs, as well as esthetic demands. Therefore, the clinician should establish a precise diagnosis and determine the most appropriate and least traumatic treatment plan. In this regard, it is not necessary to choose the most sophisticated therapy but, rather, to select the simplest and most secure treatment protocol to achieve the expected results. The treatment decision also should incorporate the most conservative and quickest option to prevent injury to the periodontal and dental structures.

Current trends in implantology: Part 1--Biological response, implant stability, and implant design.

In implant dentistry, the loss of bone is generally caused by infection or trauma but can also be attributed to other involved factors. Innovative surgical techniques and implant components have been developed in an effort to overcome the challenges (eg, bone topography and density, primary and secondary stability, aesthetics) traditionally associated with implant-supported restorations.

Current trends in implantology: part II--treatment planning, aesthetic considerations, and tissue regeneration.

UNLABELLED: In implant dentistry, bone loss is attributed to numerous factors that often include infection or trauma. Various surgical techniques and implant components have been developed to enable more effective management of such deficiencies. While the first installment of this article discussed the role of biological response and implant stability in implant therapy, this portion focuses on decision-making factors related to the number of implants, grafting materials, and achieving aesthetics with implant restorations. LEARNING OBJECTIVES: This article discusses factors that influence the outcome of implant restorations. Upon reading this article, the reader should: Be able to identify these factors and their effects. Be aware of the current trends in implant dentistry.

Root coverage with Emdogain/AlloDerm: a new way to treat gingival recessions.

The recession of the gingival margin is becoming a more prominent condition in the oral situation of many patients and should be treated at its earliest detection. The multifactorial etiology, decision modality, and current trends in the treatment of gingival recession are discussed in this article. The surgical technique of choice depends on several factors, but among the different surgical protocols available, the clinician should select one that will minimize surgical trauma and achieve predictable esthetic results. All of the approaches described in this article can effectively treat deep and shallow Class I or II buccal recessions. Recently, as an alternative to autogenous gingival grafts in root coverage procedures, enamel matrix derivative (Emdogain) and acellular dermal matrix allograft (AlloDerm) were utilized to correct these gingival defects, negating the morbidity and the requirement for a second palatal surgical procedure. Emdogain or AlloDerm materials used alone or in combination are a predictable treatment for root coverage, are relatively easy to perform (although they are technique sensitive), present low patient morbidity, offer a significant increase in the percentage of root coverage and amount of keratinized tissue, and should be part of the periodontal plastic surgery armamentarium.