Inverted bone block for a mandibular lateral ridge augmentation: A case report.

The purpose of this report is to describe an original technique for bone grafting using an inverted autogenous bone block taken from the same edentulous site that was to be implanted. A 54-year-old female presented for replacement of a missing lower premolar. Clinical and radiographical assessments revealed a deficiency in the width of the alveolar ridge. It was decided to expand the edentate area using an inverted bone block. The graft was harvested from the same edentate site that was to be implanted. The crestal bone width after nine months of healing was increased, and an implant was placed. An autogenous inverted bone block can be used as a bone grafting procedure to augment some bone-deficient sites prior to dental implantations. This novel technique provides an autogenous bone without the complexity of having a second surgical site. This technique can be used in specific situations when there is proper bone anatomy.

Guidelines for Immediate Vs Delayed Dental Implant Placement in the Esthetic Zone.

The placement of immediate dental implants in the esthetic zone is a highly successful procedure, however it requires careful case selection. Depending on the structural integrity of the alveolar socket and the gingival level, either an implant can be placed immediately and provisionalized or its insertion may need to be delayed. If the extraction site is compromised, implant placement should be deferred to allow bone or soft-tissue grafting or a combination of both to facilitate esthetic implant placement. In addition, two other treatment factors need to be considered with regard to immediate placement: (1) if the implant has low primary stability (ie, low insertion torque value), a custom healing abutment should be fabricated to maintain tissue contour and retain bone placed into the buccal gap; (2) if there is high primary stability (ie, high insertion torque value), fabrication of an immediate fixed provisional will preserve tissue contour, hold a buccal gap bone graft in place, and provide an esthetic result. At sites where the implant will be placed, factors favoring immediate placement include the following: coronal position of the gingiva compared to adjacent teeth, a type I socket classification, and class I or II sagittal root position. The purpose of this article is to present clinical guidelines that can aid in the decision-making process for delayed versus immediate implant placement.

Bone-to-Implant Contact: Its Relationship to Factors That Affect Primary and Biologic Implant Stability.

The authors assessed the literature regarding bone-to-implant contact (BIC). A wide range of mean BIC percentages was observed with respect to different commercially inserted implants. Higher BIC related to mandibular implants was found compared to maxillary fixtures and with respect to anterior versus posterior implants. Higher bone density is associated with better implant stability and BIC, while rough implant surfaces provide increased BIC versus smooth surfaces. This article discusses how to determine the percentage of BIC and describes factors that affect its values.

How to Evaluate Clinical Trials in Contemporary Dental Journals.

Knowing how to rightly interpret studies is important for dental clinicians so they can glean pertinent information that can be applied to patient care. This article describes the contents that are included in the introduction, methods and materials, results, and discussion sections of a clinical trial and emphasizes several important statistical concepts, including why a statistically significant difference does not necessarily translate to a clinically significant finding. The authors conclude that critical analyzation of a clinical trial enhances evidence-based clinical practice.

How to Present an Outstanding Dental Lecture.

Memorable presentations are educational and entertaining. Preparation is the most important key to successful lecturing. Preparation involves both researching a topic thoroughly so that the material is current and doing the foundational work to ensure the presentation is organized and rehearsed. The subject matter and intellectual level of the presentation should be appropriate for the targeted audience. Pertinently, the lecturer needs to decide if a presentation will cover a subject in a generalized or detailed manner.2 This decision often will be dictated by the reason for the lecture and the amount of time allotted for it. For example, if only 1 hour is allocated for the lecture, a detailed presentation should be limited to a few subtopics. This article offers suggestions for delivering an outstanding dental lecture. It will cover: preparedness (with respect to housekeeping chores prior to speaking to avoid potential issues), lecture presentation (effective speech delivery; eg, speed of talking), technical issues (eg, using a pointer), and other preparatory measures (eg, formulating answers to potential questions in advance of the lecture).

Efficacy of nonsurgical periodontal therapy for treatment of periodontitis: practical application of current knowledge.

This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.

High Prevalence Rates of Peri-implant mucositis and Peri-implantitis Post Dental Implantations Dictate Need for Continuous Peri-implant Maintenance.

While many clinicians are cognizant of the high survival rate of dental implants, the elevated prevalences of peri-implant mucositis and peri-implantitis post implant insertions may not be as well known. This underscores the need for greater awareness of the importance of continuous personal and professional peri-implant maintenance to facilitate implant success. The occurrence of peri-implant mucositis and peri-implantitis post implant insertions among patients ranges in studies from 46% to 63% and 19% to 23%, respectively. Individuals who undertake regular personal and professional maintenance therapy compared to patients who have irregular supportive therapy manifest reduced occurrences of peri-implant mucositis and peri-implantitis. The frequency of professional maintenance intervals usually ranges from 3 to 6 months, and its specific periodicity should be based on a patient's risk profile. Supportive care visits provide the clinician an opportunity to monitor peri-implant status. No long-term controlled clinical trials have evaluated the timing of maintenance intervals, but substantial evidence shows that professional supportive care enhances peri-implant health and the success rate of dental implants. A patient's informed consent form should include the responsibility to be compliant with personal and professional peri-implant supportive therapy.

Significance of Facial Bone Thickness After Dental Implantations in Healed Ridges: A Literature Review.

Literature has suggested that a minimum threshold of bone thickness facial to a dental implant is necessary to ensure successful implantations. The authors, therefore, decided to review the effect of buccal bone thickness on horizontal and vertical bone resorption, recession, and implant survival. Databases were searched, and seven human studies were found that evaluated the effect of facial bone thickness on hard- and soft-tissue outcomes and survival rates related to dental implants. Results revealed that a wide range of buccal bone thickness after implant placement (0.5 mm to ≥2 mm) resulted in a high implant survival rate (97% to 100%). Vertical and horizontal bone loss usually occurs following implant placement, 0.4 mm to 1 mm and 0.08 mm to 0.7 mm, respectively, after restorations are placed. Peri-implant mucosal recession of around 0.5 mm is frequently observed 1 year after implant placement. This literature review concluded that implants have a high survival rate despite a range of facial bone thickness adjacent to implants. It also found that no minimum initial facial bone thickness adjacent to an implant could be verified that would preclude horizontal and vertical bone loss after implant insertions.

Management of the Edentulous Patient: Removable Implant Prostheses.

For an edentulous patient who does not wish to cope with mastication impairment associated with a conventional denture, either in the maxilla or mandible, function can be restored with a fixed or removable implant-supported prosthesis. This article addresses management of situations when it is preferable to restore an edentulous arch with a removable implant-supported prosthesis. The differences in treatment planning concepts as they relate to the maxillary and mandibular arches are highlighted, and advantages of a bar-retained overdenture versus unsplinted implant-supported overdentures are discussed. A logical sequential approach to case management is delineated starting with determining tooth position after casts are articulated.

Management of Bleeding After Exodontia, Periodontal, or Implant Surgery.

During and after commonly performed dental surgical procedures, hemorrhaging that is greater than normal can occur in patients who do not have bleeding disorders. This article discusses the management of various potential hemorrhagic scenarios with respect to extractions and periodontal and implant surgeries. Protocols for controlling bleeding are delineated for primary and postoperative hemorrhaging. Background information is provided with respect to blood vessels, hemostatic mechanisms, patient evaluations, and drugs that may need to be suspended prior to dental surgical procedures.

Utility of measuring anterior-posterior spread to determine distal cantilever length off a fixed implant-supported full-arch prosthesis: A review of the literature.

BACKGROUND: Historically, anterior-posterior (AP) spread assessments were often used to determine the length that a distal cantilever could be extended off an implant-supported fixed full-arch prosthesis. TYPES OF STUDIES REVIEWED: The authors searched the literature for articles that used AP spread to calculate cantilever size to be constructed off implants bearing a fixed implant-supported full-arch rehabilitation. RESULTS: The data indicate that the relationship between AP spread and cantilever length is not linear and many influences (such as beam theory, cantilever size differences in the mandible versus maxilla, number and distribution of placed implants, prosthetic materials, and framework design) need to be considered when computing cantilever length with respect to fixed implant-supported prostheses. PRACTICAL IMPLICATIONS: Recommendations using AP spread assessments to compute cantilever lengths have not been validated by means of prospective scientific evaluations. Therefore, AP spread evaluation is just one of many issues that need to be considered when determining distal cantilever length associated with a fixed full-arch implant-bearing prosthesis.

Repair of Lingual Gingival Fenestrations Through the Use of a Subepithelial Connective Tissue Graft.

A gingival fenestration is a localized perforation of keratinized gingival tissue that may result in underlying bone resorption and root exposure. This case report describes treatment of mandibular lingual gingival fenestrations caused by traumatic forces from an ill-fitting removable partial denture that rested on a thin periodontal phenotype. A subepithelial connective tissue graft was used to correct these fenestrations. At the 2-year follow-up, the gingival tissues presented in a state of health.

Effectiveness of Antibiotics to Reduce Early Implant Loss in Systemically Healthy Patients.

The decision to prescribe an adjunctive antibiotic when placing a dental implant in a systemically healthy patient who is not receiving a bone graft remains a controversial issue. In an effort to elucidate this enigma, the authors analyzed, from a statistical and clinical significance perspective, seven current systematic reviews that address this concern. Hypothesis testing often does not provide clear understanding regarding the efficacy of the administration of antibiotics in association with clinical implantations. Therefore, number needed to treat (NNT) calculations may be used to determine the effectiveness of antibiotics to reduce dental implant losses. The NNT indicates how many additional patients need to be treated with antibiotics to avoid an additional implant failure in another patient. This article addresses two questions: Do antibiotics help reduce implant loss, and if they do, what is the best drug dosage to use when placing dental implants? Based on NNT calculations, the data is interpreted to denote that adjunctive antibiotics help reduce early implant loss in systemically healthy patients who are not receiving bone grafts and that 2 gm of amoxicillin prior to implant placement in non-allergic patients appears to be a satisfactory drug dose that provides a clinically significant benefit.

Creeping Clinical Attachment After Acellular Dermal Matrix Augmentation to Attain Root Coverage.

INTRODUCTION: This case report documents root coverage after using an acellular dermal matrix (ADM) combined with a tunneling procedure. The photographs and objective clinical measurements are presented to document a gain of new clinical attachment and subsequent creeping attachment. CASE PRESENTATION: A 50-year-old male who demonstrated around 6 mm of recessions on the direct facial of teeth #6 through #11 had a root coverage procedure using an ADM. After 24 months, >90% of the recession defects at all sites were eliminated. It was noted that creeping clinical attachment began to appear 6 months after initial therapy on teeth #7 through# 11. CONCLUSION: The delayed creeping attachment seems to be due to the time necessary to vascularize the ADM and the rate of vascularization may vary with different thicknesses of inserted ADM.

Hierarchy of restorative space required for different types of dental implant prostheses.

BACKGROUND: Management of the full and partially edentulous arch requires an understanding regarding the amount of vertical and horizontal restorative space that is needed for different types of dental implant prostheses. Failure to design a prosthetic construct without considering space issues can result in a rehabilitation with diminished stability, poor esthetics, and inadequate contours. Therefore, available restorative volume must be computed before initiating therapy to ensure proper prosthesis design. TYPES OF STUDIES REVIEWED: The authors searched the dental literature for articles that addressed space requirements for different types of dental implant prostheses and found a few on this subject. RESULTS: The dental literature indicates there is a 3-dimensional hierarchy of restorative space necessary for different types of implant constructs. The minimum amount of vertical space required for implant prostheses is as follows: fixed screw-retained (implant level): 4 through 5 millimeters; fixed screw-retained (abutment level): 7.5 mm; fixed cement-retained: 7 through 8 mm; unsplinted overdenture: 7mm; bar overdenture: 11 mm; and fixed screw-retained hybrid: 15mm. These dimensions represent the minimal amount of vertical rehabilitative space that can accommodate the above implant prostheses. With respect to horizontal space, computations are needed to account for the discrepancy between an implant and tooth position. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Restorative spaces for each type of prostheses are restoration specific and should be considered during treatment planning to facilitate proper case selection and enhance patient satisfaction.

Dental Implantology: Numbers Clinicians Need to Know.

Dental implantology is a discipline that merges knowledge regarding treatment planning, surgical procedures, and prosthetic endeavors. To attain optimal results many numbers pertaining to different facets of therapy are integrated into treating patients. This article outlines a wide range of digits that may assist clinicians in enhancing the performance of implant dentistry. Important integers are presented in three segments related to the sequence of therapy: pre-procedural assessments, surgical therapy, and postsurgical patient management.

The Need to Replace a Missing Second Molar With a Dental Implant Restoration: Analysis of a Controversial Issue.

Whether or not a second molar should be replaced after its removal is debatable. To assess the evidence and discuss the pros and cons of replacing a missing second molar with a dental implant restoration, the authors searched the literature for articles that evaluated the following factors: chewing efficiency, tooth loss, super-eruption, extrusion, over-eruption, and occlusal interferences. The data indicated that replacing a second molar provides some increased masticatory performance, but first-molar occlusion facilitates 90% chewing efficiency. Super-eruption of unopposed posterior teeth occurs frequently, and approximately 20% of these teeth extrude 2 mm, but the degree of over-eruption is not strongly related to the incidence of occlusal interferences. It was concluded that after a patient/dentist discussion regarding second-molar replacement, it is the patient's preference that usually dictates the decision. In this regard, if a patient perceives a chewing deficiency or dislikes having a gap in his or her dentition after the loss of a second molar, the tooth could be replaced with an implant-supported restoration. However, if the patient does not recognize any reduced masticatory efficiency, replacement of a second molar typically is unnecessary. This is due to the findings that most extrusion over time is minor and usually does not affect occlusal function; also, concerns about over-eruption can be managed in a preventive manner, and/or unopposed second molars can be monitored. Nevertheless, super-eruption of teeth can complicate restorative cases.

Cytocone Procedure: Conservative Repair of a Buccal Plate Dehiscence in Preparation for Implant Placement.

In type II sockets, the soft-tissue level is at or coronal to the cementoenamel junction, and part of the buccal plate is missing. In the esthetic zone, a patient with this type of situation often is not a good candidate for immediate implant placement until the osseous defect is repaired. Therefore, use of a conservative regenerative procedure to repair such a defective socket would be advantageous. The Cytocone procedure utilizes a nonresorbable dense polytetrafluorethylene (d-PTFE) barrier and modifies the classic "ice cream cone" technique to restore a buccal osseous defect without raising a labial flap. This article describes and illustrates the Cytocone procedure.

Implant Insertion Torque: Its Role in Achieving Primary Stability of Restorable Dental Implants.

A literature review was conducted to determine the role of insertion torque in attaining primary stability of dental implants. The review is comprised of articles that discussed the amount of torque needed to achieve primary implant stability in healed ridges and fresh extraction sockets prior to immediate implant loading. Studies were appraised that addressed the effects of minimum and maximum forces that can be used to successfully place implants. The minimum torque that can be employed to attain primary stability is undefined. Forces ≥30 Ncm are routinely used to place implants into healed ridges and fresh extraction sockets prior to immediate loading of implants. Increased insertion torque (≥50 Ncm) reduces micromotion and does not appear to damage bone. In general, the healing process after implant insertion provides a degree of biologic stability that is similar whether implants are placed with high or low initial insertion torque. Primary stability is desirable when placing implants, but the absence of micromotion is what facilitates predictable implant osseointegration. Increased insertion torque helps achieve primary stability by reducing implant micromotion. Furthermore, tactile information provided by the first surgical twist drill can aid in selecting the initial insertion torque to achieve predictable stability of inserted dental implants.