Transferring emergence profile and position of interim restorative implant fixture. A novel digital technique.

The present technical article describes a protocol to digitally reproduce the emergence profile of an interim implant prosthesis (IP) and to transfer its macrogeometry into the definitive restoration. The purpose of this protocol was to minimize alterations in the gingival architecture developed during the interim restorative phase of a single implant that could potentially jeopardize its esthetic outcome. The process included obtaining an intraoral scan with the interim IP in situ, a duplicate of this intraoral scan that was used to capture the exact position of the implant, and an extraoral scan of the prosthesis. These data could then be imported into IOS software to create a model where the patients' soft tissue was incorporated with precision, allowing for the fabrication of a definitive crown with an optimal soft tissue adaptation. As there are few articles in the scientific literature that have reported a consistent method to replicate the emergence profile of an interim IP, the present technical article aims to highlight the potential of utilizing the emergence profile of an interim IP created by IOS software.

Guided Bone Regeneration: Novel Use of Fixation Screws as an Alternative to Using the Buccoapical Periosteum for Membrane Stabilization With Sutures-Two Case Reports.

Guided bone regeneration (GBR) requires a stable graft-membrane complex. This article presents a novel technique that uses membrane fixation screws to serve as anchors for membrane stabilization sutures without the need for periosteal dissection and biting of the buccoapical periosteum. This technique may be a viable alternative when there is a preference to avoid the complexities of periosteal suturing and direct membrane fixation using tacks or screws. The technique, which utilizes anchoring screws as mooring lines, can be used at the time of tooth extraction as well as for ridge augmentation of an edentulous site in preparation for future dental implant placement. Two case reports are presented that illustrate the feasibility of the technique, in which the integrity and stability of a resorbable membrane is preserved prior to final closure, suggesting that screws used as anchors for stabilization sutures might be a predictable option when addressing challenging horizontal defects requiring GBR.

The Ribroast Technique™: An Alternative Method to Stabilize a Resorbable Collagen Membrane for Guided Bone Regeneration.

Stabilization of the graft-membrane complex during guided bone regeneration is a critically important aspect of implant dentistry. Several articles in the dental literature have introduced the utilization of periosteal biting stabilization sutures, rather than fixation screws and pins, to stabilize a bioabsorbable collagen membrane. This article reviews the concept of stabilization using sutures in periodontal regeneration and describes an alternative method, the Ribroast technique™, to stabilize a bioabsorbable membrane, whereby single periosteal biting horizontal mattress sutures are placed along the length of the defect to achieve sufficient stabilization. Two cases are presented that highlight the utility of this technique. Guidelines and limitations for the use of periosteal biting sutures are also discussed along with considerations and protocols that may be useful for improving treatment outcomes.

Use of a Sugar-Crosslinked Collagen Membrane in Conjunction With a Dehydrated Amnion/Chorion Membrane for Guided Bone Regeneration Around Immediate Implants.

Several bioabsorbable membranes have been proposed to exclude soft-tissue ingrowth and to stabilize the bone graft when guided bone regeneration (GBR) is performed. The properties of the various membranes differ slightly due to variances in composition and manufacturing processes affecting their handling and suitability for specific techniques. The aim of this article is to present a technique to perform GBR with the use of a sugar-crosslinked absorbable collagen membrane in conjunction with a dehydrated amnion/chorion membrane (dHACM). This technique can be used to perform GBR at the time of tooth extraction and for ridge augmentation of an edentulous site in preparation for future dental implant placement. The use of a collagen membrane in combination with a dHACM can facilitate stabilization of the bone graft and membrane by providing the benefits of a long-lasting bioabsorbable collagen membrane in addition to the unique benefits of an amnion/chorion membrane, which has been shown to provide growth factors to the surgical site that have potential to enhance regenerative outcomes.

Transferring the finish line of an interim restorative to the definitive cast in biologically oriented preparation technique (BOPT) procedures: A dental technique.

The biologically oriented preparation technique (BOPT) uses a vertical tooth preparation and simultaneously a controlled rotary instrumentation of the gingival sulcus. The resulting blood clot is stabilized with the interim restoration. However, accurate transfer of the emergence profile of the interim crown to the definitive restoration is essential to maintain the gingival architecture. This technique article describes clinical and laboratory procedures to predictably transfer the emergence profile of the interim crown to duplicate the gingival architecture in the definitive restoration.

The Use of a Collagen Scaffold to Augment Buccal Ridge Contour Concurrently with Implant Placement: A Two-Case Report.

The aim of this report is to present a technique for buccal soft tissue contour augmentation with the use of a porcine volume-stable collagen matrix (VSCM). Augmentation of buccal soft tissue at the time of implant placement is often a necessity but is mostly performed using autogenous tissue. The technique using a VSCM can be done at the time of implant placement or, in the case of a two-stage procedure, at the time of implant uncovering. Here, clinical outcomes are reported in two cases when using VSCM concurrently with implant placement at sites in need of buccal contour augmentation to achieve a functional, esthetic result. The use of a xenograft poses several advantages over autogenous tissue while providing similar gains in soft tissue thickness. By eliminating the need to harvest a soft tissue graft from the palate, patient morbidity is reduced, and the reliance on palatal tissue thickness, to determine the amount of achievable augmentation, is eliminated.

Severe mandibular atrophy treated with a subperiosteal implant and simultaneous graft with rhBMP-2 and mineralized allograft: a case report.

A 71-year-old patient was successfully rehabilitated by means of a 3D model-derived, hydroxyapatite-coated titanium subperiosteal mandibular implant. The implant was specifically designed to allow bone augmentation. The deficient bone was simultaneously grafted with mineralized bone allograft and recombinant bone morphogenetic protein -2 (rhBMP-2). The 32-month postoperative cone beam computerized tomography follow-up showed vertical bone augmentation beneath the implant frame.

Horizontal and vertical dimensional changes of peri-implant facial bone following immediate placement and provisionalization of maxillary anterior single implants: a 1-year cone beam computed tomography study.

PURPOSE: This cone beam computed tomography study (CBCT) evaluated horizontal and vertical dimensional changes to the facial bone following maxillary anterior single immediate implant placement and provisionalization. MATERIALS AND METHODS: CBCT scans taken immediately after (T1) and 1 year after surgery (T2) were evaluated. The midsagittal cut of each implant was identified, and measurements were made at predetermined levels. Horizontal facial bone thickness (HFBT) was measured at 0, 1, 2, 4, 6, 9, and 12 mm apical to the implant platform. Vertical facial bone level (VFBL) was the perpendicular distance from the implant platform (0) to the most coronal point of the facial bone. Measurements were recorded and changes between T1 and T2 were calculated. The data were analyzed statistically at a significance level of α = 0.05. RESULTS: CBCT scans of 21 patients were analyzed. At T2, the mean HFBT changes ranged from -1.23 to -0.08 mm at the seven different levels evaluated. The mean VFBL change was -0.82 mm. The HFBT changes at the 1- to 9-mm levels were not significantly different from one another, but they were significantly smaller than the change at the 0-mm level and significantly greater than the change at the 12-mm level. Significant positive correlations were observed only between horizontal and vertical changes and between horizontal change and initial VFBL at the implant platform. While the VFBL of eight implants (38%) was apical to the implant platform at T2, none was noted at T1. CONCLUSIONS: Dimensional changes to the peri-implant facial bone following maxillary anterior single immediate implant placement and provisionalization should be expected. The greatest HFBT change was noted at the implant platform level, in part because HFBT change is correlated to the initial VFBL and the change in VFBL at that level.