The "Scalloped Guide": A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol.

Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computer-assisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.

Flapless Postextraction Socket Implant Placement, Part 3: The Effects of Bone Grafting and Provisional Restoration on Soft Tissue Color Change-A Retrospective Pilot Study.

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

Flapless Postextraction Socket Implant Placement, Part 2: The Effects of Bone Grafting and Provisional Restoration on Peri-implant Soft Tissue Height and Thickness- A Retrospective Study.

This article presents the results of evaluating the changes in peri-implant soft tissue dimensions associated with immediate implant placement into anterior postextraction sockets for four treatment groups: no BGPR (no bone graft, no provisional restoration), PR (no bone graft, provisional restoration), BG (bone graft, no provisional restoration), and BGPR (bone graft, provisional restoration). The vertical distance of the peri-implant soft tissue was greater for grafted sites than for nongrafted ones (2.72 mm vs 2.29 mm, P < .06). The facial soft tissue thickness at the gingival third also was greater for grafted than for nongrafted sites (2.90 mm vs 2.28 mm, P < .008) and for sites with provisional restorations compared to sites without them (2.81 mm vs 2.37 mm, P < .06), respectively. The net gain in soft tissue height and thickness was about 1 mm. The increases in vertical and horizontal dimensions for grafted sites were between 0.5 and 1.0 mm, as compared to sites with no bone graft and no provisional restoration.

Flapless postextraction socket implant placement in the esthetic zone: part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study.

The dental literature has reported vertical soft tissue changes that can occur with immediate implant placement, bone grafting, and provisional restoration ranging from a gain or loss of 1.0 mm. However, little is known of the effects of facial-palatal collapse of the ridge due to these clinical procedures. Based upon treatment modalities rendered, an ensuing contour change can occur with significant negative esthetic consequences. The results of a retrospective clinical cohort study evaluating the change in horizontal ridge dimension associated with implant placement in anterior postextraction sockets are presented for four treatment groups: (1) group no BGPR = no bone graft and no provisional restoration; (2) group PR = no bone graft, provisional restoration; (3) group BG = bone graft, no provisional restoration; and (4) group BGPR = bone graft, provisional restoration. Bone grafting at the time of implant placement into the gap in combination with a contoured healing abutment or a provisional restoration resulted in the smallest amount of ridge contour change. Therefore, it is recommended to place a bone graft and contoured healing abutment or provisional restoration at the time of flapless postextraction socket implant placement.

Socket grafting with calcium phosphosilicate alloplast putty: a histomorphometric evaluation.

BACKGROUND: Socket grafting with a bone graft substitute immediately after extraction is essential to preserve the ridge architecture for implant placement. Several bone graft substitutes have been tested for their ability to effectively regenerate osseous tissue in the sockets. Evidence suggests that socket bone typically regenerates during a period of 6 to 8 months or longer, depending on several factors including the original ridge dimensions, type of graft, and the overall systemic health of the individual. The purpose of this study is to histologically evaluate the bone regeneration potential of a novel synthetic calcium phosphosilicate putty (CPS) graft substitute. METHODS: After extraction of the involved teeth, CPS putty graft was placed, and the sockets were covered with a collagen plug. Cores were taken from 20 patients for histological evaluation prior to implant placement. Ten cores were processed decalcified with hematoxylin and eosin (H&E) stain and the remaining 10 were processed undecalcified. Histomorphometric data obtained from both sets is presented. RESULTS: Histomorphometric analysis revealed an average vital bone content of 49.5 (± 20.7). A residual graft content of 4.3% (± 7.8) was observed following a healing time of 4.9 (± 0.8) months. CONCLUSIONS: Clinical and histomorphometric data suggests that CPS putty is a good choice for socket bone regeneration in implant-related surgeries.

The dual-zone therapeutic concept of managing immediate implant placement and provisional restoration in anterior extraction sockets.

Improvements in implant designs have helped advance successful immediate anterior implant placement into fresh extraction sockets. Clinical techniques described in this case enable practitioners to achieve predictable esthetic success using a method that limits the amount of buccal contour change of the extraction site ridge and potentially enhances the thickness of the peri-implant soft tissues coronal to the implant-abutment interface. This approach involves atraumatic tooth removal without flap elevation, and placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device.

Ridge preservation and augmentation using regenerative materials to enhance implant predictability and esthetics.

Dentistry has entered an era in which patients no longer need to accept an edentulous or partially edentulous condition, or one in which their candidacy for tooth structure replacement (ie, implants with subsequent restoration) must be dismissed because of insufficient alveolar bone volume, height, or width. The supporting bone can be preserved at the time of tooth extraction, or augmented at the time of case presentation, using a variety of available regenerative materials. Among them are mineralized human allograft bone and collagen membranes that can be placed in combination with specific growth factor complexes and implant designs. This article reviews the challenges associated with adequately preserving or augmenting the alveolar bone after tooth extraction or loss and before implant placement. The research and benefits to support using allogenic bone graft and membrane materials for such procedures are detailed, and 3 clinical cases are presented to demonstrate the clinically successful incorporation of these materials with the host tissues.

Timing, positioning, and sequential staging in esthetic implant therapy: a four-dimensional perspective.

Many articles address the predictability of immediate implant placement into extraction sockets; however, there are only a few reports that mention the indications and limitations of this technique. The aim of this article is to re-examine specific indications for immediate implant placement and to clarify the timing or "fourth dimension" relative to extraction and implant placement. The expanded concept of four-dimensional implant treatment planning involves the new axis of time, which must be considered along with the traditional spatial or three-dimensional management of implant positioning.