Clinical Advantages of Implant Osteotomy through the Remaining Root in Mandibular Premolar Region.

The placement of a dental implant by creating the osteotomy through the remaining root can serve as a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures such as the mental foramen and inferior alveolar nerve in close proximity to the planned osteotomy, and facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area.

A Modified Socket-Shield Technique: Simplifying the Root Sectioning Process.

Socket wall resorption leading to a loss of surrounding bone following tooth extraction has been documented in the dental literature. The use of various socket-shield techniques has been suggested as a solution to this issue. In these approaches, the tooth root is sectioned in two, and the coronal two-thirds of the buccal root is preserved in the socket. This allows the periodontium along with the bundle and buccal bone to remain intact, thus preventing or minimizing bone remodeling. According to the literature, this procedure is highly technique sensitive, especially when it comes to sectioning the root. Additionally, the procedure requires significant time, and several complications may occur, such as fenestration or luxation of the remaining root, requiring its complete extraction. This case report presents a modified socket-shield technique using a trephine bur guided by a computer-designed surgical guide to simplify root sectioning, thus reducing surgical time while increasing predictability of the outcome.

A Less-Invasive Window Design for Lateral Wall Maxillary Sinus Augmentation for Single Implants.

Maxillary sinus window design is an important factor in sinus augmentation procedures, playing a key role in managing maxillary sinus elevation complications, avoiding the sinus septum, and providing lateral support for the graft material. A less-invasive window design in comparison to conventional maxillary sinus windows was introduced with an "I"-shaped window for single implant placement. However, drawbacks of this window design have included limited instrument accessibility to the anterior sinus and incomplete membrane elevation. The purpose of this case report is to demonstrate a step-by-step surgical procedure for lateral wall maxillary sinus augmentation with a novel "J"-shaped window design for single implants.

The Custom Alveolar Ridge Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Posterior Mandible: A Case Report.

The Custom Alveolar Ridge Splitting (CARS) technique was recently reported as a less-invasive treatment option for augmentation of the maxillary anterior area in cases where alveolar width deficiency exists due to bone resorption and remodeling. This technique creates an intraosseous defect to improve success when horizontal ridge augmentation is attempted. The purpose of the present case report was to demonstrate implant placement in an atrophic posterior mandibular site using the CARS technique. This technique was used in the mandibular right second premolar area, followed by placement of a single implant. The restored implant showed stable soft and hard tissue outcomes at 6 months postloading.

The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Treatment of a Soft Tissue Depression with a Xenograft Bone Substitute at the Second Stage of an Implant Procedure: A Case Report.

Following the extraction of a compromised tooth, the edentulous alveolar ridge undergoes physiologic bone remodeling, which may create a bone volume too deficient for implant placement. Guided bone regeneration (GBR) provides a predictable treatment option to increase the alveolar bone volume for implant placement, but a soft or hard tissue deficiency may remain even after this augmentation procedure has been completed. These deficiencies can be especially challenging in the esthetic zone, where patient expectations and esthetics often determine the satisfaction of the treatment outcome. This paper presents a case report of a xenograft bone substitute used at the second-stage surgery and abutment insertion to provide a solution to these deficiencies even after the patient had undergone a GBR procedure, thus improving the esthetic and functional outcomes of the final implant-supported restoration.

Successful Implant Placement into a Site with Two Previous Failures: A Clinical and Histologic Case Report.

Implants present a predictable fixed option for patients who require tooth extraction. However, complications such as implant failure reduce the success of replacement implant restorations. A patient presented to the Department of Periodontology and Implant Dentistry (New York University College of Dentistry) with pain related to a broken implant-supported prosthesis. Two failed implants were removed, and new implants were placed. After restoration delivery, the patient reported soreness on the implant at site 35 (FDI tooth-numbering system), which was then removed (along with a sequestrum of bone) and sent for biopsy. A new implant was placed and restored successfully at the 1-year follow-up. The purpose of this case report is to demonstrate that with proper planning, surgery, and restoration, a new implant can be successfully placed and restored on a site with two previous failures. Int J Periodontics Restorative Dent 2023;43:167-172. doi: 10.11607/prd.5410.

A Retrospective Study of Implant Placement Lateral to the Inferior Alveolar Nerve (ILIAN) in Severely Atrophic Posterior Mandibular Ridges

Currently, there are several techniques being used in the posterior mandible to increase alveolar bone height and width. However, each of these has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In the current study, 26 implants in 16 patients were successfully placed lateral to IAN and restored with splinted screw-retained prostheses with a follow-up time after loading ranging from 3 months to 6 years. Two patients reported complications. One patient had a temporary paresthesia that resolved 3 months after implant placement and the second patient had minor paresthesia which was reduced after implant removal but remained in a small area on the left corner of her lip.

Reconstructing Peri-implant and Papillary Soft Tissue in the Esthetic Area Using Interdental Tissue, a Tuberosity Connective Tissue Graft, and a Tunneling Approach: A Case Report.

Long-term survival of dental implants in both fully and partially edentulous patients has been proven successful, as reported in the literature. However, maintenance of soft-tissue quality and volume is often difficult due to the multiple surgeries involved in implant placement and the physiological resorption of bone after tooth extraction. Soft-tissue augmentation is frequently necessary to improve soft-tissue contour and can be done simultaneously with implant or abutment placement or following the final insertion of the implant-supported prostheses. The purpose of this case report is to demonstrate a surgical procedure used to augment a peri-implant buccal soft-tissue defect using interdental palatal tissue from a pocket reduction procedure in combination with a distal wedge graft from the tuberosity as connective tissue utilizing a tunneling approach in the esthetic area. The implant restorations in the reported case were delivered 1 year prior to the soft-tissue reconstruction.

Regenerative Treatment of Advanced Peri-implantitis: A Retrospective Case Series with 3 to 15 Years of Follow-up.

The present case series evaluated implant survival and changes in bleeding on probing (BOP), probing depths, marginal tissue levels (recession), and bone levels following regenerative treatment of implants with advanced peri-implantitis. Forty-six implants with advanced peri-implantitis in 38 patients were treated with a regenerative protocol and evaluated for the above parameters at the final follow-up 3 to 15 years later. Patients returned every 2 to 3 months for maintenance and at the final evaluation. Measurements were made and compared to those recorded preoperatively. No implant was lost, BOP was reduced to 0 on all but 4 implants, the mean reduction in pocket depth was 6.7 mm, and the average soft tissue marginal position was 0.9 mm coronal to presurgical levels. Bone level changes showed a mean gain of 3.6 mm (radiographically) and 6.8 mm (bone sounding). These results appear to indicate that an implant with > 50% bone loss caused by peri-implantitis can successfully be treated and retained using a specific regenerative technique.

Repair of a Non-Retentive Crown Over a Press-Fit Implant Placed 30 Years Prior: A Case Report.

Dental implant treatment has been proven to be a successful therapy to rehabilitate single, partial, and fully edentulous sites. Evidence shows that the use of implant-supported restorations is predictable and can deliver long-term success. However, discontinuation of implant systems can be challenging for prosthesis maintenance. In this case report, a 70-year-old female patient presented to the implant department at New York University College of Dentistry with a press-fit implant with a one-piece cementable abutment that was placed more than 30 years prior. The patient's chief complaint was that the crown kept falling off. Upon evaluation, it was found that the implant was well-integrated in bone with no signs of infection. Explantation and replacement of the well-integrated implant was not considered the best option. An alternative approach was to address the retention of the abutment. The purpose of this case report is to demonstrate an intraoral technique for fabricating a custom cement-retained crown over a non-retentive one-piece press-fit implant.

A Narrative Review of the Diagnosis, Etiology, and Treatment of Halitosis Over the Past Three Decades.

Although the term "halitosis" was first coined in 1874, people have become increasingly aware of this problem more recently during the COVID-19 pandemic due to extensive wearing of protective masks. In fact, following dental caries and periodontal disease, halitosis is the third most prevalent reason for patients going to the dentist. Due to multifactorial etiology, the diagnosis of halitosis requires a rigorous health/dental/social history, a clinical examination, and measurements. The treatment ranges from the use of dentifrices, mouthwashes, tongue scraping, and masking products, and more recently includes photodynamic therapy, probiotics, and ozone. The purpose of this narrative review was to examine the published literature concerning halitosis over the past 30 years and discuss the diagnosis, etiology, and treatment of the disease.

A Revised Peri-implantitis Classification Scheme: Adding Three-Dimensional Considerations to Facilitate Prognosis and Treatment Planning.

Historically, diagnosing peri-implantitis is done based on whether the disease is present, evaluated using the arbitrary thresholds of probing depths and bone loss. Using this approach as a tool to ascertain meaningful information regarding prevalence and treatment is limited. Efforts have been made to improve upon this, but to date, only one of these classifications has provided a simple method to communicate disease severity based on the amount of bone loss. A modified version of this simplified classification is proposed here, including information regarding the implant position, as emerging information suggests that this is a crucial factor in the etiology and prognosis of peri-implantitis. This enhancement to the classification better serves both researchers and clinicians in their discussion about peri-implantitis and helps to determine and recommend the most effective methods of management.

Long-term Results of Maxillary Full-Arch Reconstruction Using Transitional Implants: A Case Report With 20-Year Follow-up.

Because of their documented long-term success rates, dental implants have become a predictable treatment option to replace hopeless or missing teeth. However, full-arc transition from a hopeless dentition to a prosthesis supported by dental implants remains a challenge. One treatment option for this process is the use of transitional implants, an approach that allows for the transitioning of full-arch reconstructions from teeth to implant-supported prostheses without immediate loading the permanent implants or the need for provisional removable partial dentures. This article, which presents a long-term clinical case report, describes the steps and sequence of therapy involved in transitioning from a hopeless dentition to a maxillary full-arch implant-supported fixed prosthetic rehabilitation with the use of transitional implants, avoiding removable provisional prostheses. An assessment of the 20-year follow-up, dental implant survival rates, and marginal bone loss is also presented.

A Retrospective Study of Bone-Level Stability Around 335 Hybrid Implants Placed with an Immediate or Delayed Protocol.

This retrospective study evaluated 335 hybrid implants placed in edentulous ridges; 167 were placed with an immediate implant protocol (IIP) and 168 were placed with a delayed implant protocol. Radiographic bone level changes were measured 1 to 23 years after loading. The average bone loss between implant placement and second-stage loading was 0.16 mm in the delayed group and 0.12 mm in the IIP group. Average bone loss from implant loading to the final radiograph was 0.26 mm in the IIP group and 0.13 mm in the delayed group. There was statistically significantly more bone loss in the IIP group, in patients taking amoxicillin (vs those taking azithromycin), in sites with splinted implants (vs nonsplinted implants), and in smokers (vs nonsmokers). However, even when statistically significant, bone loss would be considered clinically insignificant by most clinicians over the 1- to 23-year follow-up.

Effect of alveolar ridge preservation on clinical attachment level at adjacent teeth: A randomized clinical trial.

PURPOSE: To test whether or not alveolar ridge preservation (ARP) changes the clinical attachment level (CAL) at adjacent teeth of extraction sockets after 6 months. MATERIAL AND METHODS: Seventeen patients requiring bilateral tooth extractions of the upper molars were recruited. After tooth extraction, the sockets were randomly allocated to two groups applying a split-mouth design: (1) ARP using deproteinized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen membrane and (2) spontaneous healing (control). CAL, probing pocket depth (PD), bleeding on probing (BOP), gingival recession (REC), and bone levels were evaluated at the adjacent teeth of the extraction sockets at baseline and after 6 months of follow-up. RESULTS: A total of 14 patients were available for reexamination. From baseline to 6 months of follow-up mean CAL changes of all six sites at adjacent teeth of the extraction sockets amounted to -0.23 ± 0.65 mm (gain) in ARP group and 0.05 ± 0.86 mm (loss) in the control group with significant differences in favor of ARP (p = 0.04). The CAL gain was significantly more favorable at mesiopalatal sites (p = 0.01). Consistently, the mean reduction of PD of all six sites amounted to -0.68 ± 0.84 mm in ARP and -0.34 ± 0.74 mm in the control group (intergroup p = 0.02). The PD reduction was significant (p = 0.001) at the mesiopalatal sites in ARP. BOP, REC, and bone levels showed no significant differences between the groups (intergroup p > 0.05). CONCLUSION: Although ARP with DBBM-C revealed a trend toward CAL gain and PD reduction at adjacent teeth of extraction sites, these adjunctive benefits seem to be clinically negligible.

Improving Free Gingival Graft Success Around Implants Using a Completed Implant Restoration.

Keratinized mucosa around implants is considered essential for maintaining peri-implant health. Clinicians may find it necessary to augment keratinized tissue after implant loading when complications arise. Immobilizing the graft can be challenging when there is a complete absence of attached gingiva or when the vestibule is shallow creating an opportunity for muscle forces to move the graft. To overcome these limitations, various stents have been created aimed at improving the stability of soft-tissue grafts around implants; however, many of these stents have drawbacks. This case report presents a novel approach for improving free gingival graft immobility and success around implants that utilizes a completed implant restoration.

A New Concept of Safety Distance to Place Implants in the Area of the Inferior Alveolar Canal to Avoid Neurosensory Disturbance.

Inferior alveolar nerve (IAN) damage following implant placement is a severe complication that can compromise a patient's quality of life. Previous studies have suggested that a safety zone of 2 mm, if maintained, might avoid this problem. This retrospective study evaluates implants placed in closer proximity to the IAN without resulting in any postoperative neurologic complications and suggests a new concept of safety distance. A total of 60 consecutive patients receiving 101 mandibular implants < 2 mm from the IAN were included in this study. All enrolled patients had a CBCT scan done for radiologic assessment before implant placement and following final restoration. Measurements were obtained through cross-sectional views using Simplant software. In patients without neurologic disturbances, a mean distance of +0.75 mm was seen from the closest portion of the implant to the nerve bundle. In cases where a direct transection and/or compression of the nerve was not observed, the patients did not experience neurosensory disturbances.

Accuracy of Cone-Beam Computed Tomography Versus Periapical Radiography Measurements When Planning Placement of Implants in the Posterior Maxilla: A Retrospective Study.

Intraoral periapical (PA) radiography is commonly used for measuring the remaining crestal bone height when implants are treatment planned in the maxillary posterior region. A major drawback of conventional radiographs is that a 3-dimensional (3D) entity is compressed and superimposed on itself into a 2-dimensional (2D) image, which is often distorted. Conversely, 3D information can be extracted from computerized tomography. The purpose of this article is to evaluate and discuss limitations of intraoral PA radiography for the measurement of posterior maxillary alveolar bone height and describe the use of information obtained by means of 3D computerized tomography to help plan implant placement. METHOD: Clinical data in this study was obtained from the Implant Database (ID) at New York University College of Dentistry (NYUCD). The data set was extracted as de-identified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at NYUCD. The ID is certified by the Office of Quality Assurance at NYUCD. This study is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements. Thirty-five sites were compared with both PA and cone-beam computed tomography (CBCT) images of the posterior region, including the anatomical relationship of the maxillary crest to the sinus floor. The values recorded from the CBCT were used as the standard to which PA was subtracted from. RESULTS: Linear differences were consistently seen in which the remaining maxillary posterior crestal bone height appeared larger or smaller on the PA radiographs when compared to the measurements made of the same area on the CBCT images. CONCLUSION: CBCT imaging is a valuable adjunct in radio-anatomical and radio-diagnostic observations in the posterior maxillary region. Furthermore, in this study CBCT measurements were shown to be more accurate in assessing the remaining crestal ridge height apical to the sinus membrane when compared to PA radiographs. More research is necessary to verify these findings.

The Custom Alveolar Ridge-Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Anterior Maxilla: A Retrospective Case Series Study.

Implant-supported restorations have proven to be a predictable option for replacing missing teeth. In cases of inadequate bone quantity, the bone volume can be increased by bone augmentation procedures. Several factors can affect bone regeneration, including the morphology of the defect at the implant site. A defect surrounded by bony walls (an intraosseous defect) is known to yield a highly successful regeneration. The purpose of this retrospective case series study was to present a new step-by-step surgical procedure known as the Custom Alveolar Ridge-Splitting (CARS) technique for maxillary anterior ridge augmentation. This technique creates an intraosseous defect while splitting and augmenting an atrophic ridge. Sixteen consecutive cases were treated with the CARS procedure. All implants were restored and followed for 12 to 24 months after loading, and all cases were effectively treated with successful implant placement. According to this retrospective study, the CARS procedure is simple, successful, and predictable and may be used as a surgical option for horizontal alveolar ridge augmentation in the anterior maxilla.