Flapless Extraction Socket Healing Around an Immediate Implant Placed into a Mandibular Molar Site Without the Use of Regenerative Materials: A Case Report.

The aim of this case report is to expand on previous studies of flapless immediate implant placement in sites with a large gap distance, without the application of regenerative materials. In this case report, an immediate implant was placed in a fresh molar extraction site with a large gap distance from the implant surface to the socket walls without the use of a bone graft, membrane, or coronal flap advancement for primary closure. Clinical healing was consistent with spontaneous extraction socket healing. Uncovery at 3 months revealed complete socket fill and secondary stability of the implant. After 2 years and 2 months, bone levels remain stable. This case report demonstrates the natural healing potential of an extraction socket, which can provide sufficient bone healing and dimensional stability for implant osseointegration and a functional restoration.

Compromised Hard- and Soft-Tissue Architecture: Immediate Implant Placement and Provisionalization in the Esthetic Zone.

Careful case selection is crucial for achieving short- and long-term success with immediate implant placement and provisionalization. Caution should be exercised for a tooth that presents with a compromised soft- and hard-tissue architecture. Nevertheless, a successful outcome can be achieved provided that the principles elucidated in the current literature are applied. The following report describes a case with a severely reduced but healthy periodontium around a tooth scheduled for extraction. Immediate implant placement and provisionalization utilizing the extracted tooth with simultaneous hard- and soft-tissue augmentation were performed in one surgical visit. This facilitated the restoration of a healthy peri-implant tissue complex and delivery of a functional and esthetic final implant-supported restoration.

Correcting Mucogingival Deformities at the Time of Extraction for a Future Implant Site: A Case Report.

INTRODUCTION: Existing soft tissue deformities around a tooth planned for extraction and replacement with a dental implant may jeopardize the esthetic and physiologic outcome of any dental implant treatment. If soft tissue deformities can be prevented, minimized, or corrected at the time of tooth extraction for the future implant site and the adjacent teeth, more predictable outcomes with superior esthetics and health can be accomplished along with fewer surgical visits. CASE PRESENTATION: This case report describes a patient who presented with mucogingival deformities around a tooth scheduled for extraction and subsequent implant placement. The adjacent tooth also presented with similar characteristics. Surgical modifications and refinements were used by performing an epithelialized free gingival graft (E-FGG) at the time of tooth extraction to enhance the tissue quality of the future implant site and its neighboring tooth. CONCLUSION: The identification of inadequate attached gingiva in the area of future implant placement and neighboring teeth in the treatment planning phase can enable clinicians to address any mucogingival deformities with E-FGGs at the time of extraction without subjecting the patient to any additional surgical visits and healing time.

Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma.

PURPOSE: To evaluate the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging for distinguishing paraduodenal pancreatitis (PDP) from pancreatic head duct adenocarcinoma (CA) in patients with diagnoses confirmed by histopathologic analysis. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board and is HIPAA compliant. Between July 2007 and July 2010, 47 patients who underwent Whipple procedure and MR imaging less than 60 days before surgery were identified retrospectively. Two relatively inexperienced fellowship trainees with 9 months of body fellowship training were asked to record the presence or absence of three MR imaging features: focal thickening of the second portion of the duodenum; abnormal enhancement of the second portion of the duodenum; and cystic focus in the expected region of the accessory pancreatic duct. Strict criteria for diagnosis of PDP included presence of all three imaging features. Any case that did not fulfill the criteria was classified as CA. Sensitivity, specificity, positive predictive value, and negative predictive value for characterization of PDP was calculated for each reader with 95% confidence intervals. A κ test assessed level of agreement between readers. RESULTS: Each reader correctly categorized 15 of 17 (88.2%) PDP cases when all three imaging criteria were met. Alternatively, 26 of 30 (86.7%) pancreatic duct CA were correctly categorized as inconsistent with PDP. Four patients with histopathologic diagnosis of CA were incorrectly classified as PDP by each reader. Agreement between the two readers showed substantial κ agreement for the diagnosis of PDP and differentiation from pancreatic duct CA. CONCLUSION: Contrast-enhanced MR imaging may help accurately identify PDP and distinguish it from CA when strict diagnostic criteria are followed. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112056/-/DC1.

A modified ridge Expansion technique in the maxilla.

Localized ridge expansion of a deficient edentulous maxillary alveolar ridge segment is a useful technique when the goal of surgery is to provide an increase in ridge width as a means of establishing an adequate alveolar crest capable of receiving endosseous implants. The purpose of this article is to describe several modifications to the original ridge-splitting technique for deficient maxillary ridges. These modifications include full-thickness flap reflection, elimination of vertical intraosseous incisions, and simultaneous incorporation of guided bone regeneration. The modifications help to decrease complications associated with the original ridge-splitting technique while increasing the predictability of ridge augmentation in the buccal-palatal dimension. A case is presented that demonstrates the efficacy of the modified technique.

A liquid membrane as a barrier membrane for guided bone regeneration.

Membranes made of several different materials are available in the market, nonresorbable (e.g. ePTFE), resorbable (e.g. synthetic or collagen) and liguid applicable (e.g. Polyethylene glycol or Atrisorb). The purpose of the present study was to evaluate whether or not in situ application of Atrisorb could be used as a barrier membrane for guided bone regeneration. Ten patients with insufficient alveolar ridge width for implant placement participated in the study. Atrisorb in conjunction with various bone grafts was used to treat 10 different sites, 3 sites treated prior to implant placement and 7 sites in conjunction with implant placement. Augmented sites were allowed to heal for 3 to 7 months, with mean healing time of 4.7 months. Healing was uneventful with no major complications. Two sites experienced a flap dehiscence accompanied by barrier exposure during the initial healing period. Secondary healing was achieved soon after with no signs of infection, giving Atrisorb a barrier exposure rate of 20% for the present study, which corresponds to favorably to that of resorbable membranes. The liquid membrane has the potential of being a viable alternative to traditional resorbable membranes for use in GBR procedures.