Dental implants at sites of focal high and mixed density osseous lesions: Treatment strategies.

FOCUSED CLINICAL QUESTION: Under what circumstances may a clinician consider dental implant placement at a site exhibiting a focal high or mixed density (HMD) osseous lesion radiologically? SUMMARY: Some conditions and pathologic entities exhibiting high and mixed density radiological appearance pose low risk for dental implant failure or complications following implant surgery. However, other lesions represent contraindications to implant placement, and implant surgery at such sites can result in severe morbidity. CONCLUSION: Potential implant sites exhibiting focal HMD osseous lesions/conditions present varying levels of risk. In most cases, optimal management will include advanced imaging of the site, multidisciplinary consultations, and detailed informed consent to assure full understanding of procedural risks, benefits, and complications. Currently, clinical recommendations rely on case reports, opinion, and usual practice (level 3 evidence). The strength of each recommendation provided in this report is categorized as level C.

Clinical protocol selection for alveolar ridge augmentation at sites exhibiting slight, moderate, and severe horizontal ridge deficiencies.

FOCUSED CLINICAL QUESTION: What factors identify the optimal bone augmentation techniques for managing slight, moderate, and severe horizontal alveolar ridge deficiency (ARD) at dental implant sites? SUMMARY: Horizontal ARD is a concern at a high proportion of sites receiving dental implants, and clinicians have developed a variety of surgical procedures to address such defects. In a particular case, selection of the optimal treatment may depend predominantly on defect severity, location (anterior versus posterior), and configuration (contained versus noncontained). This report provides a framework for selecting an augmentation method when presented with a slight, moderate, or severe horizontal ARD at a site requiring dental implant placement. CONCLUSION: Multiple treatment options are available for planned implant sites exhibiting horizontal ARD; severe posterior and slight anterior defects intuitively call for different approaches. Although rigid guidelines for selecting the optimal augmentation method do not exist, some techniques are poorly suited for esthetically demanding sites. A framework considering defect severity, location, and configuration may help guide clinical decisions on this topic.

Should Periodontists Prescribe Postoperative Oral Corticosteroids to Control Pain and Swelling? A Systematic Review.

FOCUSED CLINICAL QUESTION: In generally healthy patients receiving third molar, periodontal, or dental implant surgery, do postoperative oral corticosteroids effectively limit pain and swelling compared with placebo or alternative medications?

The Triangle Suture for Membrane Fixation in Guided Bone Regeneration Procedures: A Report of Two Cases.

INTRODUCTION: Existing evidence supports superior treatment outcomes in guided bone regeneration (GBR) procedures employing membrane fixation. The purpose of this report is to present a specific flap design and suturing method for stabilizing GBR barrier membranes. CASE PRESENTATION: Two generally healthy patients received GBR using native collagen membranes stabilized with absorbable sutures. In both cases, we fixed barrier membranes apically using "triangle" sutures. Sling sutures (Case 1) or triangle sutures (Case 2) secured the crestal and palatal aspects of the membranes. No postoperative complications occurred, and both sites exhibited favorable alveolar ridge volume for implant placement. CONCLUSIONS: The described triangle suture technique reliably stabilized GBR barrier membranes without the need for fixation hardware. Compared with suturing methods that limit graft volume and apply pressure over the grafted area, the triangle suture may offer clinical advantages.