Immediate placement and provisionalization of maxillary anterior single implant with guided bone regeneration, connective tissue graft, and coronally positioned flap procedures.

Immediate implant placement and provisionalization in the esthetic zone have been documented with success. The benefit of immediate implant placement and provisionalization is the preservation of papillary mucosa. However, in cases with osseous defects presenting on the facial bony plate, immediate implant placement procedures have resulted in facial gingival recession. Subepithelial connective tissue grafts for immediate implant placement and provisionalization procedures have been reported with a good esthetic outcome. Biotype conversion around implants with subepithelial connective tissue grafts have been advocated, and the resulting tissues appear to be more resistant to recession. The dimensions of peri-implant mucosa in a thick biotype were significantly greater than in a thin biotype. Connective tissue graft with coronally positioned flap procedures on natural teeth has also been documented with success. This article describes a technique combining immediate implant placement, provisionalization, guided bone regeneration (GBR), connective tissue graft, and a coronally positioned flap in order to achieve more stable peri-implant tissue in facial osseous defect situations.

Classification of sagittal root position in relation to the anterior maxillary osseous housing for immediate implant placement: a cone beam computed tomography study.

PURPOSE: The purpose of this study was to classify the relationship of the sagittal root positions of the maxillary anterior teeth to their respective osseous housings using cone beam computed tomography (CBCT). The frequency of each classification was also reported. MATERIALS AND METHODS: A retrospective review of CBCT images was conducted on 100 patients (40 men, 60 women; mean age, 53.1 years) who fulfilled the inclusion criteria. The CBCT images were evaluated and the relationship of the sagittal root position of the maxillary anterior teeth to its associated osseous housing was recorded as Class I, II, III, or IV. RESULTS: The frequency distribution of sagittal root position of maxillary anterior teeth indicated that, of the 600 samples, 81.1%, 6.5%, 0.7%, and 11.7% were classified as Class I, II, III, and IV, respectively. CONCLUSIONS: An understanding of the clinical relevance of sagittal root position will provide adjunct data for the treatment planning of immediate implant placement and provisionalization in the anterior maxilla. A classification system may lead to improved interdisciplinary communication in treatment planning for implant-based therapy in the anterior maxilla.

[Interdental papilla reconstruction with prosthodontic treatment of maxillary central incisor: case report].

PATIENT: A 20-year-old female whose chief complaint was esthetic disturbance of a crown placed on the maxillary left central incisor. DISCUSSION: The interdental papilla was reconstructed only by the prosthodontic treatment of maxillary left central incisor. This case suggests that the proximal and subgingival contours of provisional crown is very important to the reconstruction of interdental papilla, and also suggests that the transmission of the information regarding the configuration of a provisional crown to the lab side is very important. CONCLUSION: This case shows that the emergence profile of a single crown, especially of its proximal aspect, is important to reconstruct the interdental papilla.

Fracture resistance of inlay-retained fixed partial dentures reinforced with fiber-reinforced composite.

In this study, the effect on the fracture load of inlay-retained composite fixed partial dentures (FPDs) caused by reinforcing them with fiber-reinforced composite (FRC) in different positions was examined. Experimental FPDs were fabricated using Estenia/EG Fiber (Kuraray Medical). Pontic reinforcement was then performed in one of the following three ways: reinforced the central area in a single line or in double straight lines, or reinforced the bottom in a curved line. The finding was that, when the area ranging from the connector to the bottom of the pontic was reinforced with FRC in a curved line, the fracture load of the FPDs tended to become higher. In addition, the FPDs fractured mainly at the veneering composite of the connector area. Based on the results of this study, it was concluded that reinforcement using FRC is effective, and that the veneering composite in the connector area needs to have sufficient strength to prevent the fractures.

Stress analysis of endodontically treated anterior teeth restored with different types of post material.

Finite element analysis was performed to evaluate stress distribution in maxillary central incisors treated endodontically and restored with a post and an all-ceramic crown. Tensile stress at tooth root was analyzed using two-dimensional finite element models with different post diameters and lengths. One post length was 1/3 of the root (short), while the other was 2/3 of the root (long); one post diameter was 1/3 of the root (narrow), while the other was 2/3 of the root (wide). The following combinations were used for posts and cores: gold alloy cast post and core, commercial stainless steel post and resin core, and fiber post and resin core. Results showed that the fiber post produced less stress on the root dentin around the post tip than did the metal posts. This finding thus suggested that to reduce the stresses that cause root fracture, a long, thin fiber post should be used.

Finite element analysis of fiber-reinforced fixed partial dentures.

Two-dimensional finite element models were created for a three-unit posterior fixed partial denture. An experimental resin-impregnated glass fiber was used as the fiber-reinforced composite (FRC) for the framework. The FRC was evaluated using varying combinations of position and thickness, alongside with two types of veneering composite. A load of 50 N simulating bite force was applied at the pontic in a vertical direction. Tensile stress was examined using a finite element analysis program. Model without FRC showed tensile stress concentrations within the veneering composite on the cervical side of the pontic--from the connector area to the bottom of the pontic. Model with FRC at the top of the pontic had almost the same stress distribution as the model without FRC. Models with 0.4-0.8 mm thick FRC positioned at the bottom of the pontic showed maximum tensile stresses reduced by 4-19% within the veneering composite.

Adhesive strength between fiber-reinforced composites and veneering composites and fracture load of combinations of these materials.

PURPOSE: This study examined the influence of the adhesive strength between fiber-reinforced composites (FRC) and veneering composites on the fracture load of combinations of these materials. MATERIALS AND METHODS: Six materials were used. An experimental material called BR-100, Vectris, and FibreKor were the types of FRC. Estenia, Targis, and Sculpture were used as veneering composites. With the Estenia/BR-100 combination, the surface of the FRC was subjected to three different conditions before veneering. Ten specimens of each combination were fabricated and divided into two groups: One group was stored in 37 degrees C distilled water for 24 hours, and the other was thermocycled (4 degrees C/60 degrees C, 10,000 cycles). Adhesive strength between FRCs and veneering composites was determined using the compressive shear strength test. In addition, fracture loads of laminate specimens were determined. RESULTS: Good adhesive strength was obtained by leaving an unpolymerized layer on the surface of the FRC or by performing silane and bonding treatment. In the Estenia/BR-100 combination, when the adhesive strength was low, the fracture load of the laminate specimens was also low. However, the difference in fracture load was not as large as that seen in adhesive strength. The fracture load of each laminate specimen was significantly lower after thermocycling. CONCLUSION: The adhesive strength between the FRCs and veneering composite had an effect on the fracture load of the combination.

Strength and elastic modulus of fiber-reinforced composites used for fabricating FPDs.

PURPOSE: The purpose of this study was to examine the flexural strength and elastic modulus of a new fiber-reinforced composite used for the fabrication of inlay-retained fixed partial dentures (FPD). MATERIALS AND METHODS: A total of six materials were used: Vectris, FibreKor, and an experimental material, BR-100, were the types of glass fiber preimpregnated with resin used for making the frameworks; Targis, Sculpture, and Estenia were used as the veneering composites. Five specimens of each material were prepared. Flexural strength and elastic modulus were determined using the three-point bending test. In addition, laminate specimens were fabricated by combination of the veneering composite and framework materials (Targis/Vectris, Sculpture/FibreKor, and Estenia/BR-100), and fracture loads of these specimens were determined. Laminate specimens were fabricated with three different framework thicknesses for Estenia/BR-100. RESULTS: Estenia had the greatest strength and highest modulus of elasticity of the veneering composites. All three framework materials had flexural strength values (567 to 686 MPa) more than three times as great as those of the veneering composites (132 to 193 MPa). Of the laminate specimens, the Estenia/BR-100 with a framework thickness of 1.0 mm had a fracture load more than 50% greater than Targis/Vectris and Sculpture/FibreKor. CONCLUSION: The combination of the experimental framework material BR-100 and the composite Estenia showed higher fracture loads than the other combinations tested.