Time management in multistep periodontal and implant treatments: a practical guide.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

Evaluation of bone density by cone-beam computed tomography and its relationship with primary stability of dental implants.

Background: One of the critical factors determining the success of dental implants is primary stability. This study aimed to determine the density of jawbones in the implant candidate sites via cone-beam computed tomography (CBCT) and its correlation with the values obtained from resonance frequency analysis during surgery. Materials and Methods: In this descriptive-analytic study seventeen implant sites requiring implant placement were selected. Impressions were sent to the laboratory to construct a surgical guide via the stereolithographic method. An electronic surgery was performed on the chosen implant sites according to each patient's CBCT information entered into the Kaveh surgical guide software. The bone density of the target areas was calculated using the gray value (voxel value). After preparing the final osteotomy, an implant was installed in the area according to the manufacture's recommendation. The relevant Osstell® SmartPeg was selected and installed on the implant body to determine the primary stability. Kolmogorov-Smirnov test and the correlation pearson correlation statistical test. used for statistical analyze. P value amounts < 0.05 was considered significant. Results: The mean and standard deviation of the gray scale in this study were 563.7 ± 218.8 and 65.3 ± 7.7 implant stability quotient (ISQ) respectively. The correlation between gray scale and ISQ was evaluated by the Pearson correlation test, and the results indicated a strong correlation between the two variables. Conclusion: The voxel value and primary stability had a normal distribution and strong correlation. In other words, the gray scale determined by CBCT imaging techniques at the proposed implant site could be used to assess the bone density before the surgery.

Histological and histomorphometric evaluation of the synthetic biomaterial Natix® in horizontal reconstruction of alveolar ridge.

BACKGROUND: Following loss of teeth, atrophy of alveolar ridge of the jaws is a substantial problem and unintended outcome that compels clinicians to perform bone reconstruction ahead of implant placement. Although autogenous bone is recommended as the gold standard in bone reconstruction, aninvasive second surgery harvestinga limited volume of bone (from intraoral source) has led a significant approachingthe use of synthetic bone substitute materials. The aim of this study was to evaluate the histologic and histomorphometric properties of porous titanium granules (Natix®) used in horizontal reconstruction of alveolar ridge before implant placement. MATERIALS AND METHODS: In the present quasi-experimental clinical trial, four patients (three females and one male) needed horizontal bone augmentation on ten areas of edentulous mandibular ridge before implant treatment. During surgery, the buccal aspect of edentulous ridge was augmented by Natix®, covered by resorbable membrane (Cytoplast®). After 8 months, 10 core biopsies were obtained. RESULTS: In histological study, no foreign body reaction at the site of the newly formed bone or around the biomaterial residue was observed. Newly formed bone was fully vital with large lacunae containing osteocytes. In 60% of cases, connective tissue was observed at the biomaterial - new bone interface. In histomorphometric study, mean percentage of bone formation was 40.56% ± 19.83% and mean bone trabecular thickness was 39.98 ± 17.54 µ. CONCLUSION: Despite acceptable histological and histomorphometric bone formation findings, in clinical terms, no increase was created in the horizontal dimension. Thus, it seems that application of this biomaterial in horizontal reconstruction of alveolar ridges with noncontained defects is inappropriate.