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1.
J Periodontol ; 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33829501

RESUMEN

Bleeding on probing (BOP) is regarded as an indispensable diagnostic tool for evaluating periodontal disease activity, however its role in peri-implant disease is more intricate. Much of the confusion about the interpretation originates from drawing parallels between periodontal and peri-implant conditions. BOP can originate from two forms of probing in implants: traumatic or pathologic induction. This, in addition to the dichotomous scale of BOP can complicate diagnosis. The objectives of this editorial include: (1) to discuss the value of BOP as a d6iagnostic tool for peri-implant diseases; (2) the reasons it should be distinct from value for diagnosing periodontal and peri-implant diseases; and (3) the current best evidence on how to implement it in daily clinical practice. A comprehensive bleeding index is proposed for evaluating and monitoring peri-implant conditions. Conclusion: BOP should be used in addition to other parameters such as visual signs of inflammation, probing depth, and progressive bone loss before a peri-implant diagnosis is established. This article is protected by copyright. All rights reserved.

2.
Artículo en Inglés | MEDLINE | ID: mdl-33819319

RESUMEN

Implant-related esthetic demands have increased tremendously in recent years. The presence of shallow papillae or open interproximal spaces (black triangles) are some of the most troubling dilemmas in dentistry. Among the many factors associated with the presence of papilla or papilla height, the interproximal bone is one of the main factors dictating the presence of an adequate papilla between implants. The present case report describes a patient with severe hard and soft tissue deficiencies with a high smile line in the esthetic zone, requiring multiple implants. The step-by-step process of the utilized techniques for achieving inter-implant papilla reconstruction through a multidisciplinary approach using both hard and soft tissue augmentation procedures, as well as soft tissue conditioning with customized abutments, is delineated.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Estética Dental , Estudios de Seguimiento , Encía , Humanos , Maxilar
3.
Artículo en Inglés | MEDLINE | ID: mdl-33819337

RESUMEN

Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.


Asunto(s)
Implantes Dentales , Placa Dental , Periimplantitis , Tejido Conectivo , Implantes Dentales/efectos adversos , Humanos , Periimplantitis/cirugía , Colgajos Quirúrgicos
4.
J Periodontol ; 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33720410

RESUMEN

BACKGROUND: The aim of this study was to determine if a previous history of periodontitis according to the preset definitions of the 2017 World Workshop is correlated with increased implant failure, and occurrence and severity of peri-implantitis (PI). METHODS: A retrospective analysis of patients with a history of periodontitis who received nonsurgical and, if indicated, surgical corrective therapy prior to implant placement was performed. Periodontitis stage and grade were determined for each included patient based on data from the time of initiation of active periodontal therapy. Cox Proportional Hazard Frailty models were built to analyze the correlation between stage and grade of periodontitis at baseline with implant failure, as well as occurrence and severity of PI. RESULTS: Ninety-nine patients with a history of periodontitis receiving 221 implants were followed for a mean duration of 10.6 ± 4.5 years after implant placement. Six implants (2.7%) failed and a higher rate of implant failure due to PI was found for grade C patients (P < 0.05), whereas only an increased trend was seen for stages III and IV compared with I and II. Grading significantly influenced the risk of marginal bone loss (MBL) >25% of the implant length (P = 0.022) in PI-affected implants. However, a direct correlation between higher-level stage and grade and PI prevalence was not recorded. CONCLUSION: No statistically significant association between periodontitis stage or grade and the prevalence of PI was found. However, when PI was diagnosed, there was a relationship between periodontitis grade and severity of PI or the occurrence of implant failure.

5.
Artículo en Inglés | MEDLINE | ID: mdl-33786888

RESUMEN

OBJECTIVE: To clinically evaluate the use of a titanium-reinforced PTFE mesh for vertical bone augmentation (VBA) of deficient alveolar ridges. MATERIALS AND METHODS: This case series documented consecutive patients treated for VBA with a newly developed PTFE mesh. VBA was performed in anterior and posterior, maxillary and mandibular arches using anorganic bovine bone combined with autogenous graft in a 1:1 ratio. Healing time from initial surgery to re-opening was recorded. Baseline vertical deficiency, absolute bone gain (gross height gained), and relative gain (percentage of defect fill with respect to the baseline deficiency) were registered. RESULTS: 57 patients (65 defects) were included in the analysis. The mean baseline vertical deficiency was 5.5 ± 2.6 mm. The mean absolute bone gain was 5.2 ± 2.4 mm. A relative gain of 96.5 ± 13.9% was achieved. Overall, 89.2% of cases showed complete regeneration, which occurred in all sites with baseline deficiencies of < 5 mm, in 95.6% of sites with 5-8 mm deficiencies, and in 89.4% of sites with > 8 mm deficiencies. Each 1-mm addition to the baseline height deficiency increased the likelihood of incomplete bone regeneration by 2.5 times. Defect location had a statistically significant but a limited clinical impact on the bone height gained (<0.5mm). Complications were observed in three cases (3%). CONCLUSIONS: VBA with titanium-reinforced PTFE mesh and a mixture of autologous bone and xenograft is a safe and predictable procedure. The extent of the baseline vertical deficiency influences the percentage of bone gained.

6.
Artículo en Inglés | MEDLINE | ID: mdl-33660930

RESUMEN

INTRODUCTION: How to best classify the Stage III and IV periodontitis cases that share common features of the most severe clinical attachment loss and the most severe radiographic bone loss? CASE PRESENTATION: Two patients presented features of generalized periodontitis, with severe probing depth and clinical attachment loss that would meet inclusion in both Stage III and IV. The cases retained all teeth but were further complicated by teeth drifting and secondary occlusal trauma. Appropriate disease classification required clinical judgement and led to the final classification of Stage III, Grade C for both cases. CONCLUSION: Patient-based clinical judgement, aiming for long-term preservation of natural dentition, drives the final assignment of staging when the case falls in the "gray zone" that focuses on major differences in Stage III and IV periodontitis.

7.
Clin Oral Investig ; 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33609186

RESUMEN

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.

8.
Artículo en Inglés | MEDLINE | ID: mdl-33595206

RESUMEN

INTRODUCTION: A disharmonious smile results from excessive gingival exposure or gingival margin misalignment is a frequent finding in patients. The most common cause is altered passive eruption; however, in the case presented here, the esthetics of the smile is compromised also due to an inadequate implant placement and crown fabrication. CASE PRESENTATION: This case presented a combination of altered passive eruption and a buccally as well as deeply placed implant crown (#10) that led to disproportionate dimensions of an upper lateral incisor. Dual digitally guided crown lengthening surgical procedure for teeth #5 to #12 was performed aiming a better harmony of the smile. Treatment also included placement of tooth veneers and re-made of implant crown. A pleasant smile with appropriate colors and proportions was achieved. All esthetic and periodontal health parameters were maintained throughout the follow-up period (1 year). CONCLUSION: The use of dual digitally guided crown lengthening help to accomplish precision and stability of esthetic outcome, as it guides for both, bone and soft tissue removal. Particularly, in challenging cases with high esthetic demand and complicated factors present, such as the case presented here, the digital approach provides tools to attain excellent treatment outcome.

9.
Artículo en Inglés | MEDLINE | ID: mdl-33528445

RESUMEN

Vertical bone augmentation (VBA) procedures for dental implant placement are biologically and technically challenging. Systematic reviews and meta-analyses of studies on VBA have failed to identify clinical procedures that provide superior results for treatment of the vertical ridge deficiencies. A decision tree was developed to guide clinicians on selecting treatment options based on reported vertical bone gains (< 5 mm, 5 to 8 mm, > 8 mm). The choice of a particular augmentation technique will also depend on other factors, including the size and morphology of the defect, location, and clinician or patient preferences. Surgeons should consider the advantages and disadvantages of each option for the clinical situation and select an approach with low complications, low cost, and the highest likelihood of success.


Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/cirugía , Trasplante Óseo , Árboles de Decisión , Implantación Dental Endoósea , Humanos
10.
Artículo en Inglés | MEDLINE | ID: mdl-33528448

RESUMEN

The aim of this article is to propose a simplified digital protocol for the treatment of the fully edentulous patient, using an immediate implant and immediate loading protocol to deliver a polymethyl methacrylate metal-reinforced hybrid prosthesis. Ten consecutive patients were treated with this approach. At the end of 1 year, there was an implant survival rate of 97.8% and a prosthetic success rate of 100%. Based on the responses to the quality of life questionnaire, patients had a high acceptance rate for this treatment protocol. Within the limits of this case series, the proposed simplified digital protocol could be utilized for reconstruction in the fully edentulous patient and for delivering an implant-supported prosthesis immediately after implant placement.


Asunto(s)
Implantes Dentales , Carga Inmediata del Implante Dental , Arcada Edéntula , Boca Edéntula , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Estudios de Seguimiento , Humanos , Arcada Edéntula/cirugía , Boca Edéntula/cirugía , Calidad de Vida , Resultado del Tratamiento
11.
Artículo en Inglés | MEDLINE | ID: mdl-33629419

RESUMEN

OBJECTIVES: To compare the intra-osseous temperature reached during bone drilling for dental implant placement using open versus closed static surgical guides and evaluate the influence of bone density, osteotomy drilling depth, and irrigation fluid temperature. MATERIAL AND METHODS: 960 osteotomies were performed with 2 mm pilot drills in 16 solid rigid polyurethane foam blocks. Two main variables were considered: the guide type (open or closed guide) and bone density (hard (D1) or soft (D4). The blocks were divided into four groups according to the type of surgical template and bone density as follows: group one: closed guide and hard bone; group two: open guide and hard bone; group three: closed guide and soft bone; and group four: open guide and soft bone. A combination of different experimental conditions was used, including different bone osteotomy depths (6 or 13 mm) and irrigation fluid temperatures (5°C or 21°C). RESULTS: The highest mean temperature was found in group one (28.29 ± 4.02°C). In the soft bone groups (three and four), the mean maximum temperature decreased compared to groups one and two (dense bone) and was always higher with closed guides (23.38 ± 1.92°C) compared to open guides (21.97 ± 1.22°C) (p < .001). The osteotomy depth and irrigation fluid temperature also significantly influenced the bone temperature (p < .001), especially in hard bone. CONCLUSIONS: The greatest heat generation was observed in high-density bone. The final intra-bone temperature was about 1°C higher with a closed static surgical guide than with an open guide. The heat generation in osteotomy sites was substantially reduced by cooling the irrigation fluid to 5°C.

12.
J Periodontol ; 2021 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33386743

RESUMEN

BACKGROUND: Immediately placed single implants with either immediate provisionalization (test) or delayed restoration (control) were followed for up to 1 year in our previous randomized clinical trial. Peri-implant tissues continue to remodel after implants are in function. Therefore, the primary aim of this study was to evaluate the facial mucosal level changes in the intermediate term between the two groups and to study potential factors influencing the mucosal level change. METHODS: Patients who had already completed the previous clinical trial by receiving a single immediately placed implant were re-invited to this study. The facial mucosal level as well as the other peri-implant hard and soft tissue dimensions and conditions were measured clinically, radiographically and with ultrasound. These data were compared between the test and control implants. The mucosal level change as the function of the final crown contour, measured as the abutment-crown angle (ACA), was estimated with a linear regression model. RESULTS: Twenty-eight patients (n of test/control = 16/12) with a mean 30-month follow-up were recruited. The mean mucosal level change was -0.38 mm (control) and 0.06 mm (test), without statistical difference between the two groups. The other clinical, radiographic, and ultrasound parameters were not statistically different. ACA was statistically significant associated with the recession (P = 0.02). The estimate effect was 0.25 mm per 10° increase (adjusted R2  = 0.18; 95% CI, 0.02 to 0.49 mm). After adjusting for vertical implant position, implant abutment angle and the group, the effect became borderline significant (P = 0.09). CONCLUSIONS: Peri-implant tissues, including the mucosal level change of immediately placed implants with either immediate provisionalization or delayed restoration remained stable and did not differ between the groups in the intermediate term. The final crown angle, influenced by implant position and abutment angle, might be associated with mucosal margin level change.

13.
J Clin Periodontol ; 2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33465812

RESUMEN

AIM: To describe the application of power Doppler Ultrasonography (US) for evaluating blood flow at implant and palatal donor sites following soft tissue augmentation with the connective tissue graft (CTG). MATERIALS AND METHODS: Five patients exhibiting a peri-implant soft tissue dehiscence received treatment with a coronally advanced flap and corresponding CTG. Power Doppler US was used for assessing blood volume at baseline, 1 week, 1 month, 6 months and 12 months post-surgery for assessing blood-flow dynamics at the implant and palatal donor sites. The speed-weighted and power-weighted colour pixel density (CPPD) were computed from colour velocity (CV) and colour power (CP), respectively. RESULTS: A mean increase in CV of 199.25% was observed at the midfacial region of the implant sites after 1 week compared to baseline. CV and CP were increased in all sites at 1 week and 1 month. At 6 and 12 months, the mean CV appeared lower than baseline at the implant sites. CCPD was increased at the palatal donor sites and at the great palatine foramen areas at the 1-week and 1-month post-operative evaluations. CONCLUSIONS: Power Doppler US is a non-invasive and valuable tool for estimating tissue perfusion and CPPD variation during different phases of intra-oral soft tissue graft healing.

14.
J Esthet Restor Dent ; 33(1): 212-223, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33459483

RESUMEN

OBJECTIVE: To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. OVERVIEW: The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. CONCLUSIONS: While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. CLINICAL SIGNIFICANCE: Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Implantación Dental Endoósea , Estética Dental , Fenotipo
15.
Clin Oral Implants Res ; 32(3): 349-358, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33420729

RESUMEN

OBJECTIVES: To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability. MATERIALS AND METHODS: Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. RESULTS: Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters. CONCLUSION: The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Teorema de Bayes , Odontólogos , Estética Dental , Humanos , Reproducibilidad de los Resultados , Resultado del Tratamiento
16.
J Clin Periodontol ; 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33484162

RESUMEN

AIM: To assess the ability of two-way interactions between baseline stage, grade and extent to predict tooth loss due to periodontitis (TLP) over a long-term follow-up period. MATERIALS AND METHODS: Patients treated for periodontal disease with a complete medical history, baseline periodontal chart, full mouth radiographs and a minimum of ≥10 years follow-up were recruited. Supportive periodontal therapy (SPT) visits were recorded during the entire follow-up period. Patients were categorized according to their stage, grade and extent. The absolute survival at 10-, 20-, and 30-year follow-up was calculated for TLP. Kaplan-Meier survival curves were plotted at the tooth-level and multilevel Cox regression frailty models were constructed in order to assess the association among predictive variables and TLP by taking into account the hierarchical patient-teeth structure. RESULTS: 442 patients (11,125 teeth) with a mean follow-up of 23 years met the inclusion criteria and were included in this study. The most prevalent diagnosis at baseline was stage III grade B (30.3%), followed by stage II grade B (23.5%). Among the parameters analysed, stage and grade were found to be the best predictors of TLP. Statistically significant differences were observed for extent only in patients with severe disease (stage IV or grade C). The multilevel Cox regression analysis demonstrated that patients with higher concomitant baseline staging and grading developed greater TLP over the follow-up period. CONCLUSIONS: Higher concomitant staging and grading corresponded to greater risk for TLP and generalized extent only became a significant predictor in patients with stage IV or grade C disease.

17.
Int J Oral Maxillofac Implants ; 35(6): 1159-1169, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33270056

RESUMEN

PURPOSE: To compare the accuracy of different modalities of implant placement-static fully guided, static half-guided, and freehand surgery-through meta-analysis. MATERIALS AND METHODS: A thorough electronic and manual systematic search was conducted to identify applicable randomized clinical trials (RCTs) for evaluating the implant positioning accuracy between different static implant navigation surgeries. The coronal and apical horizontal deviation, vertical deviation, apical angle, and chair time were estimated as the weighted mean differences and standard deviation with confidence intervals. A P value of .05 was set for statistical significance. RESULTS: Based on the 10 RCTs that met the inclusion criteria for the quantitative analyses, results from the meta-analyses demonstrated the following: (1) a coronal deviation significant difference favoring the fully guided approach compared with the half-guided (weighted mean difference of -0.51 mm) and freehand approaches (weighted mean difference of -1.18 mm); (2) a significant weighted mean difference between the fully guided and half-guided approaches in relation to the apical deviation (weighted mean difference of -0.75 mm); (3) the vertical comparison did not yield significant weighted mean differences between the fully guided and half-guided techniques (-0.23 mm) and lacked statistically significant difference between the fully guided and freehand techniques (weighted mean difference of -0.17 mm); (4) the apical angle deviation demonstrated a significant weighted mean difference in favor of the fully guided approach compared with the half-guided group (weighted mean difference of -3.63 degrees); and (5) the comparison of chair time between the investigated groups did not exhibit a significant difference in any of the techniques. CONCLUSION: Static fully guided implant navigation surgery has the highest accuracy for transmitting the presurgical positioning planning to the patient, followed by static half-guided surgery, while the freehand implant placement provides the least accuracy.

18.
J Oral Implantol ; 2020 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-33270835

RESUMEN

Different types of internal implant-abutment connections, namely hexagon and conical, have been used for implant restoration. However, data regarding the benefits of these internal connections in terms of clinical outcomes are scarce. Accordingly, the aim of this study was to compare radiographic marginal bone loss (RMBL) and associated implant complications between implants with internal hexagon (IH) connections and those with internal conical (IC) connections. Forty-nine patients with 98 implants (two per patient) placed in the posterior mandible were recruited. All implants were inserted in pairs in solid D2 bone according to a randomized sequence; the first patient received an IH connection implant on the mesial side while the second patient received an IC connection implant on the mesial side. Each patient received one implant with an IH connection and one with an IC connection, placed side-by-side. Four months after placement, all implants were loaded with single screw-retained ceramic restorations with internal hexagon or conical connections. RMBL and complications, including implant/prosthesis failure, were recorded at the time of implant loading (baseline) and 6, 12, and 36 months after loading. The results revealed no significant between-group differences in RMBL (P = .74), gingival bleeding on probing (P = .29), and complications (P = .32). Thus, the type of internal implant-abutment connection did not affect clinical outcomes, including RMBL and implant/prosthesis failure. Future studies should additionally evaluate long-term prosthesis-related complications such as screw loosening and fracture between the two types of internal connections.

19.
J Prosthet Dent ; 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33317830

RESUMEN

The virtual articulator is a tool that reproduces the relationship between the jaws in a virtual environment. The purpose of this clinical report was to describe a completely digital protocol starting from the virtual articulator mounting to developing static and dynamic occlusion in a complex prosthetic rehabilitation.

20.
Artículo en Inglés | MEDLINE | ID: mdl-33382524

RESUMEN

INTRODUCTION: Guided bone augmentation often requires extensive releasing of the mucoperiosteal flap to achieve primary wound closure, an invasive procedure that can compromise the keratinized tissue volume and increase patient morbidity. Amnion-chorion membranes have been used to actively promote healing in chronic open-wound situations in the medical field, suggesting that they could be used in a similar manner in the oral cavity.The ability to use open-wound healing techniques for guided bone regeneration would allow clinicians to avoid invasive procedures that cause additional tissue trauma at the surgical site. CASE SERIES: Amnion-chorion membranes were applied over the bone grafting material augmenting localized horizontal ridge defects, and a gap between the flaps was left intentionally during healing. Minor flap releasing procedures were performed in these cases, which demonstrated uneventful soft tissue healing, good volume of bone regeneration and preserved keratinized tissue. CONCLUSIONS: Preliminary clinical outcomes suggested contained minor horizontal ridge defects may be treated satisfactorily in a controlled, open-wound healing manner that reduces surgical trauma, chair time, and patient morbidity.

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