Saving teeth: Revisited. Esthetic improvement and long-term periodontal stability of a pathologic tooth migration case: An 84-month follow-up.

INTRODUCTION: Advances in implant dentistry, often influence our clinical treatment planning and steer us as periodontists from our fundamental values of preserving teeth. Pathologic tooth migration (PTM) of maxillary anterior teeth is a common sequela of periodontitis in patients and results in significant esthetic and functional problems. Patients' growing concern about the esthetics of their teeth and their fears of losing teeth are often reasons for them to seek treatment. We commonly assign a hopeless prognosis to these pathologically migrated teeth because of the significant loss of periodontal support and go with the "safer" choice of replacing them with implants. The purpose of this case report is to present the long-term (7-year) periodontal stability of compromised teeth and to emphasize the successful outcomes achieved when orthodontics, non-surgical periodontal, and restorative treatments are combined. METHODS AND RESULTS: A 38-year-old, otherwise healthy male with compromised function and esthetics, PTM, periodontal disease, and missing teeth presented to our clinic. Primary treatment objectives were to 1) eliminate the periodontal inflammation and 2) restore and stabilize the occlusion by employing non-surgical periodontal treatment, adult orthodontics, and prosthodontics. Following interdisciplinary treatment, clinical and radiographic re-evaluation revealed significant clinical attachment gain, reduction in tooth mobility, favorable esthetics, and better overall prognosis. At an 84-month follow-up, the patient was periodontally healthy and retained his natural dentition. CONCLUSIONS: Interdisciplinary collaboration along with patient compliance may increase the longevity of periodontally compromised teeth and improve esthetics for periodontitis patients who suffer from PTM. Such long-term favorable outcomes reaffirm the value of classic periodontal treatment and the success of multidisciplinary treatment to save teeth as a viable alternative to the extraction of teeth and the placement of implant retained restorations.

A Retrospective Study of Implant Placement Lateral to the Inferior Alveolar Nerve (ILIAN) in Severely Atrophic Posterior Mandibular Ridges

Currently, there are several techniques being used in the posterior mandible to increase alveolar bone height and width. However, each of these has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In the current study, 26 implants in 16 patients were successfully placed lateral to IAN and restored with splinted screw-retained prostheses with a follow-up time after loading ranging from 3 months to 6 years. Two patients reported complications. One patient had a temporary paresthesia that resolved 3 months after implant placement and the second patient had minor paresthesia which was reduced after implant removal but remained in a small area on the left corner of her lip.

A new technique to identify the location of the mucogingival junction on computer tomographic scans before implant placement.

A new technique is presented to identify the location of mucogingival junction (MGJ) on CT scans before implant placement. This case report describes the step-by-step fabrication of a radiographic template, which when used in conjunction with CT scans enables the clinician to locate the position of MGJ before implant placement and predict the amount of keratinized tissue (KT) that will be present around an implant. Using this technique, the operator can determine whether or not flapless implant surgery may be a treatment option and whether simultaneous soft tissue augmentation will be necessary at the time of implant placement to establish an adequate band of KT.

Analysis of stress relaxation in temporization materials in dentistry.

OBJECTIVE: Although temporization is intended as an interim step, complexity of individual treatment situations may demand medium to longer term use of temporary appliances in clinical practice. The durability and integrity of these restorations for continued use to meet the treatment demands is therefore an important clinical problem. The goal of this study was to evaluate the short to medium term stability of these materials under controlled loading to study their stress relaxation behavior. METHODS: Acrylic resins (poly(methyl) and poly(ethyl) methacrylate) and bis-acryl composite resins were tested in vitro in this study. The stress decay data with time (under an applied constant strain) due to internal strain caused by molecular relaxation were systematically analyzed using important parameters derived from stress changes with time. RESULTS AND SIGNIFICANCE: The results showed significant differences in the stress relaxation behavior between different materials which may have significant bearing on their durability in medium to longer term interim clinical applications. Poly(ethyl) methacrylate (PEMA) resins subjected to applied constant strain over a period of time showed large time dependent decay of applied stress, indicating very high internal molecular relaxation effects, relative to those of poly(methyl) methacrylate (PMMA) and bis-acryl composites. The results showed that PMMA and composite resins were superior in their ability to maintain constant strain without excessive dissipation of applied stress than PEMA resin. This suggests that internal strain caused by molecular relaxation events may lead to excessive dimensional instability in PEMA.