Ridge Width Alteration After Implant Placement Into the Fresh Extraction Socket With Deproteinized Bovine Bone Mineral and Acellular Dermal Matrix.

INTRODUCTION: Immediate implant placement into a fresh extraction socket in an esthetic zone can be challenging because a reduction in ridge width after healing will result in gingival asymmetry. CASE SERIES: In this case series, 17 consecutively treated patients with 19 immediately placed implants between maxillary second bicuspids were included. Only sites with an intact facial plate were included. If dehiscence or fenestration was found on the facial plate during extraction, the site was excluded. The implant was placed toward the palatal side, allowing a ≥2 mm gap between the implant body and the facial plate. This gap was grafted with deproteinized bovine bone mineral (DBBM). Sharp dissection and grafting using acellular dermal matrix (ADM) were performed on the facial side. A custom-made healing abutment was connected to the implant and allowed to heal for 3 months. Preoperative and 3-month postoperative models were used to measure the alteration in the ridge width at 2 and 5 mm from the preoperative gingival margin at the midfacial point. All implants healed without complications and integrated appropriately. Measurement comparison showed a 0.1 mm reduction and a 0.5 mm increase in the ridge width at the 2- and 5-mm positions, respectively. Biotype did not make difference in the outcome. CONCLUSION: This case series demonstrates that, when DBBM and ADM were used during immediate implant placement into an intact extraction socket, minimal to no alteration in the ridge width was observed after 3 months of healing.

Effect of implant surface and grafting on implants placed into simulated extraction sockets: a histologic study in dogs.

PURPOSE: To study bone healing at implant sites in simulated extraction sockets with 1-mm marginal defects and compare healing around a turned surface (T) to that around a porous oxide surface prepared by anodic oxidation (AO) with or without the use of an autogenous bone graft. MATERIALS AND METHODS: All mandibular premolars and first molars were extracted from 10 mongrel dogs. After 9 weeks, four sites were prepared on both sides of all mandibles. Each osteotomy was widened in the coronal 5 mm to create a marginal defect of 1 mm around the implants. Autogenous bone was collected during the drilling procedure. The sites were randomized to receive implants with a T or an AO surface, with or without bone grafting. The animals were sacrificed 4 months after implant placement for histologic analysis. RESULTS: Clinically, all sites healed with complete bone fill. The combination of an AO implant and a bone graft resulted in a significantly greater percentage of bone-to-implant contact (BIC) (P < .05) versus all other groups. The highest point of BIC was achieved with the AO group, which was significantly greater than the lowest group (T). No significant differences between groups were found when the apical 4 mm (non-gap areas) were compared (P = .65). CONCLUSIONS: Studies have demonstrated that bone can fill in a marginal defect around a titanium implant with varied histologic BIC, depending on implant surface type and defect dimensions. Based upon this animal study using 10 mongrel dogs, marginal circumferential defects of 1 mm showed significantly higher BIC values for implants that were prepared by AO compared to implants with a turned surface. The addition of autogenous bone grafts further enhanced the degree of BIC.

Treating complex cases using an interdisciplinary approach for predictable aesthetic and functional outcome.

UNLABELLED: The successful introduction of endosseous implants has significantly changed dental treatment planning and therapy. To date, implants can be utilized not only to convert removable prostheses into fixed restorations, but also to improve the overall functional and aesthetic outcome. The sequence of treatment involving the different disciplines in the comprehensive treatment of the patient is an important factor needed to achieve excellence in complex restorative cases. This article presents a comprehensive interdisciplinary approach to a complex full-mouth fixed reconstruction in the aesthetically and functionally compromised partially edentulous patient. LEARNING OBJECTIVES: This article describes a sequential approach to the interdisciplinary treatment of a partially edentulous patient. Upon reading this article, the reader should be able to: Understand the relevance of proper diagnosis and treatment planning on full-mouth rehabilitations. Identify the goals for the various sequences involved in treating complex restorative cases.

Advanced surgical techniques to enhance implant success in the maxilla.

While less emphasis has traditionally been placed on aesthetics in order to focus on successful osseointegration, increased success rates provided by contemporary endosseous root-form dental implants have improved postoperative peri-implant hard and soft tissue structures. The criteria for the evaluation of implant success should, therefore, include lack of pain, mobility, radiolucency, bone loss, infection, or paresthesia, as well as acceptability and stable aesthetics. This article discusses surgical means to preserve or restore hard and soft tissues around dental implants to achieve ideal and predictable outcomes.

Rehabilitation of the edentulous mandible with a fixed implant-supported prosthesis.

UNLABELLED: Implant rehabilitation of an edentulous mandible presents significant improvements over conventional complete denture therapy with regard to patient satisfaction, and it can improve a patient's quality of life. Several implant prosthetic designs have been developed and successfully utilized in clinical practices. The goal of this article is to describe the prosthetic design and technical steps in the fabrication of a fixed implant-supported mandibular prosthesis. A technique is described in which the positioning of appropriately selected abutments is completed in a predictable manner. LEARNING OBJECTIVES: This article discusses the prosthetic designs and technical steps in fabricating a fixed implant-supported mandibular prosthesis. Upon reading this article, the reader should: Understand the prosthetic design for the treatment of an edentulous mandible. Recognize the significance of the technical steps in this rehabilitation process.