The "washing line" suture technique for securing the Subepithelial Connective Tissue Graft.

Following tooth extraction, resorption of the buccal wall of the socket will occur; this will be true for both the maxilla and the mandible. Where the extraction site is surrounded by natural dentition, the loss of the buccal alveolar plate can degrade the visual aesthetics of an implant-supported prosthetic rehabilitation. To aid the harmonization of the hard and soft tissue morphology, both hard and soft tissue augmentation can be carried out either consecutively with an extraction/immediate implant placement or prior to an implant placement in the delayed scenario. The contemporary method of increasing soft tissue volume is to use the Subepithelial Connective Tissue (auto) Graft (the SCTG). The graft requires fixation, otherwise it can be extruded from the recipient site. This article presents a novel suturing technique which can confidently secure the SCTG, thus resisting its dislodgement.

Aberrations Causing Neurovascular Damage in the Anterior Maxilla during Dental Implant Placement.

When dental implants are being considered for placement in the maxillary central incisor region, proximity to the nasopalatine canal and its contents needs to be accounted for. The morphology of the canal changes with age. The availability of CBCT has allowed the in-depth analysis of this important variable anatomy. However, an associated important anatomical structure can be easily overlooked: the "canalis sinuosus." This is a neurovascular canal carrying the anterior superior alveolar (ASA) nerve and artery. CBCT frequently shows the canalis sinuosus (CS) as a wide canal lateral to the nasal cavity and also under the anterior part of the nasal floor in close proximity to the NPC. The CS distributes both neural supply and vascular supply to the maxillary anterior teeth which on CBCT sagittal analysis are seen as very fine circular canals having nondistinct walls. The author presents a case history of dental implant placement in the anterior maxilla which resulted in neurovascular disturbance as a result of invasion of the nasopalatine duct and injury to its contents together with the unidentified injury to an aberrant well-defined neurovascular canal inferior to the canalis sinuosus.

An Analysis of Patient Perceptions and Expectations to Dental Implants: Is There a Significant Effect on Long-Term Satisfaction Levels?

Here we present an analysis of patient perceptions and expectations to dental implant placement and their prosthetic reconstruction, to then consider whether they have an effect on long-term satisfaction levels. A Post-Treatment Completion Questionnaire was designed to analyse whether patient satisfaction is influenced by age and/or gender; has an effect on patient-reported self-confidence levels; contributes to increased levels of oral hygiene; provides further insight into the average pain levels during and after the surgical intervention; or influences further acceptance of dental implant surgery. And then whether relationships exist between any of these factors. 182 consecutive patients completed the survey: 68 males and 114 females (age mean 64.68 years ± 11.23 SD); the average number of months since treatment completion was 37.4 (males) and 62.6 (females). There is a significant relationship between comfort rating and "how well informed" the patient was (p = 0.015). A significantly positive relationship exists between "considering dental implants in the future" and "overall experience" (p = 0.001). A significantly positive relationship exists between "overall satisfaction with appearance" and "satisfaction with comfort" (p = 0.011). A significant relationship exists between "overall satisfaction with appearance," "satisfaction with comfort," and "overall satisfaction with experience" (p = 0.001). The results amplify the need to transmit logical, truthful information to patients when dental implant treatment is being considered. The "fully informed" patient will have realistic expectations that lead to high degrees of satisfaction.

Advanced peri-implantitis cases with radical surgical treatment.

PURPOSE: Peri-implantitis, a clinical term describing the inflammatory process that affects the soft and hard tissues around an osseointegrated implant, may lead to peri-implant pocket formation and loss of supporting bone. However, this imprecise definition has resulted in a wide variation of the reported prevalence; ≥10% of implants and 20% of patients over a 5- to 10-year period after implantation has been reported. The individual reporting of bone loss, bleeding on probing, pocket probing depth and inconsistent recording of results has led to this variation in the prevalence. Thus, a specific definition of peri-implantitis is needed. This paper describes the vast variation existing in the definition of peri-implantitis and suggests a logical way to record the degree and prevalence of the condition. The evaluation of bone loss must be made within the concept of natural physiological bony remodelling according to the initial peri-implant hard and soft tissue damage and actual definitive load of the implant. Therefore, the reason for bone loss must be determined as either a result of the individual osseous remodelling process or a response to infection. METHODS: The most current Papers and Consensus of Opinion describing peri-implantitis are presented to illustrate the dilemma that periodontologists and implant surgeons are faced with when diagnosing the degree of the disease process and the necessary treatment regime that will be required. RESULTS: The treatment of peri-implantitis should be determined by its severity. A case of advanced peri-implantitis is at risk of extreme implant exposure that results in a loss of soft tissue morphology and keratinized gingival tissue. CONCLUSIONS: Loss of bone at the implant surface may lead to loss of bone at any adjacent natural teeth or implants. Thus, if early detection of peri-implantitis has not occurred and the disease process progresses to advanced peri-implantitis, the compromised hard and soft tissues will require extensive, skill-sensitive regenerative procedures, including implantotomy, established periodontal regenerative techniques and alternative osteotomy sites.

Coalescence of inter: Osteotomy bone graft material inserted via separate transcrestal sinus osteotomies: A case report and concise review of the literature.

When multiple implants are to be placed, and a pneumatized sinus exists, the published reports suggest that the lateral window approach (LWA) is favored for sinus floor augmentation. Simultaneously, if a transcrestal sinus floor augmentation has been carried out (bone-added osteotome sinus floor elevation), the reports are restricted to single implant placement at any site. The aim of this study was to evaluate the clinical and radiographic outcomes at adjacent transcrestal sinus augmentation grafts using deproteinized bovine bone material, with the immediate placement of submerged adjacent implants, and so determining the fate of the graft material. The progressive loss of the inter-implant graft is reported for the LWA Technique. However, this novel coalescence method has shown a progressive increase in the inter-implant graft region, thus inferring a positive bony regeneration and remodelling at the region. These results indicate that the carrying out of a large scale study is warranted to confirm the efficacy of this technique.