Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study.

INTRODUCTION: Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. METHODS: Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ). RESULTS: A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. CONCLUSIONS: Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants. CLINICAL SIGNIFICANCE: This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Periodontal Phenotype Modification of Peri-Implant Soft Tissue Deficiency Using Subepithelial Connective Tissue Grafts and Bone Grafts in the Esthetic Region.

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3-6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes.

Changes in sinus mucosal thickening in the course of tooth extraction and lateral sinus augmentation with surgical drainage: A cone-beam computed tomographic study.

OBJECTIVES: The objective of the study was to evaluate the radiographic changes in sinus mucosal thickness (SMT) in patients with mucosal thickening of odontogenic origin after maxillary molar extraction and lateral sinus augmentation with simultaneous surgical drainage and implant placement. MATERIALS AND METHODS: Forty-six patients were included in this study. The changes in SMT were evaluated using cone-beam computed tomography images produced at four time points: before extraction (T0), before surgery (T1), immediately after surgery (T2), and after prosthesis delivery (T3), and statistical differences between time points were analyzed. The changes in SMT and augmented bone height (ABH) regarding the reason of extraction, smoking, ostial patency, and the presence of postoperative sinusitis were also evaluated. RESULTS: Over time points, SMT gradually decreased (T0: 19.44 ± 9.22 mm, T1: 15.10 ± 8.89 mm, T2: 8.42 ± 6.01 mm, and T3: 4.16 ± 4.91 mm) (p < .05). Five out of 6 patients with ostial obstruction at T1 presented ostial patency at T3. Two patients developed postoperative sinusitis but recovered with medication. Ostial patency at T1, SMT at T1, and reason of extraction did not statistically significantly influence SMT at T3. SMT at T1 had no statistically significant impact on ABH change between T2 and T3. CONCLUSION: Sinus mucosal thickness was gradually reduced by extraction of compromised teeth and drainage during lateral sinus augmentation. The drainage contributed more to the reduction in SMT.

African American Women's Willingness to Participate in Online Health Communities During COVID-19.

Introduction: The use of online health communities (OHCs) for health information, disease self-management, and social support increased during the COVID-19 pandemic. However, there are limited data on the willingness of African American women (AAW) to participate in OHCs. Materials and Methods: A sample of 985 AAW completed an online survey. Multinomial logistic regression examined associations between three age groups (18-29, 30-50, and 51+ years) and 10 motivators and 10 barriers to participating in OHCs. Women 51+ years were the referent group. Results: Women 51+ years were more likely to have been diagnosed with obesity and hypertension than the other groups (p < 0.01), but less likely to be diagnosed with a mental health condition than the other groups (p < 0.01). The top 2 motivators were to learn about a disease/condition (70%) and to prevent a disease/condition (64%). There were no significant differences with these variables. However, compared with women 18-29 years of age, women 51+ years were more likely to be motivated to manage an illness (p < 0.001), and more likely than the other groups to be motivated to support others (p = 0.011). The top 2 barriers were being too busy (53%) and privacy concerns (45%). Compared with women in the two other groups, women 51+ years were more concerned about privacy (p < 0.001). Discussion: AAW expressed a willingness to participate in OHCs. Willingness to participate in OHCs will vary by the topic and disease/condition and the age group. Conclusions: Opportunities exist to recruit AAW in age-specific OHCs.

Successful Management of Late Sinus Graft Infection via Functional Endoscopic Sinus Surgery and Press-Fit Block Bone Graft: A Case Report.

The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site that led to a late sinus graft infection and sinusitis with an oroantral fistula (OAF), by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with 3 implants placed simultaneously in the right atrophic ridge. However, No. 3 and 4 implants were removed due to advanced peri-implantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an OAF. The patient was referred to an otolaryngologist for FESS to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the OAF site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the OAF site and grafted. After 4 months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered 6 months after implant placement. After the 2 years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage OAF and vertical defects at the implant site.

The Bone Bridge Technique Utilizing Bone from the Lateral Wall of the Maxillary Sinus for Ridge Augmentation: Case Reports of a 1-7 Year Follow-Up.

The post-extraction socket of a periodontally compromised tooth/implant is oftentimes accompanied by a very wide-deep alveolar ridge defect. The commonly utilized treatment is ridge preservation followed by delayed implant placement 4 to 6 months after extraction. In the four cases presented in this study, a novel technique of utilizing a bone block obtained from the lateral wall of the maxillary sinus is introduced. Due to the severe localized vertical ridge deficiency, an intraoral autogenous bone block was obtained from the ipsilateral sinus bony window. After the obtained bone block was properly trimmed, it was fixed in the form of a bridge over the vertical defect by the press-fit method. In two cases, the gap between the autogenous bone and defect was filled with a particulate synthetic bone graft, and in another two cases, the gap was left without grafting. All cases were covered with a resorbable collagen membrane. At the time of re-entry after 5 to 6 months, the bone bridge was well incorporated beside the adjacent native bone and helped by the implant placement. Uncovering was performed after 3 to 6 months, and prostheses were delivered after 2 months. Oral function was maintained without any change in the marginal bone level even after the 1- to 7-year post-prosthesis delivery. This case series showed that the bone bridge technique performed using an ipsilateral sinus bony window for a localized vertical deficiency of a post-extraction socket can be used for successful vertical ridge augmentation (VRA).

Successful Implant Placement via Simultaneous Nasal Floor Augmentation in an Inferior Meatus Pneumatization Case.

Partially edentulous patients who present with inadequate bone height in the posterior maxillary can predictably be rehabilitated with lateral wall sinus augmentation and subsequent implant placement. However, the sinus augmentation is defined by variations observed in the anatomical presentation of the maxillary sinus. Herein, we describe a case study managing sinus augmentation when a rare anatomic variant termed inferior meatus pneumatization was observed. A 65-year-old female patient presented, wherein the inferior meatus of the nasal cavity was located directly above the maxillary posterior dentition as opposed to the maxillary sinus. The clinically atrophied maxilla was rehabilitated by employing nasal floor elevation, bone augmentation, and simultaneous implant placement. Post-operatively, no sino-nasal complications were recorded. Subsequently, 8 months after the initial procedure, osteointegration of the implants along with the presence of vital bone was observed. The patient posterior occlusion in the upper right quadrant was rehabilitated by engaging the stable implants with a cement-retained fixed final prosthesis. Follow-ups recorded for up to 2 years demonstrated no further complications. The case report demonstrates diagnosis, appropriate treatment, and management of inferior meatus pneumatization and a viable surgical approach for augmentation and implant treatment.

Lateral Peri-Implantitis: Successful Management via Guided Bone Regeneration at Mandibular First Molar Implant.

Infections occurring around implants are divided into marginal peri-implantitis and retrograde peri-implantitis (RPI). Marginal peri-implantitis starts in the crestal bone and progresses to the apical portion, and RPI starts in the apical bone and progresses to the coronal portion. However, lateral peri-implantitis (LPI) occurring on the side of the implant body has not yet been reported, and the cause is unclear. This 63-year-old male patient is a case of unusual bone resorption that occurred in the lateral portion of the implant body 26 months after lateral bone augmentation. The origin of LPI was an infection at the site of laterally augmented bone. Rather than implant removal, this report demonstrates an alternative treatment option of guided bone regeneration after the enucleation and detoxification of the implant surface with successful clinical and radiographic results for 2 years.

Submerged Technique of Partially De-Epithelialized Free Gingival Grafts for Gingival Phenotype Modification in the Maxillary Anterior Region: A Case Report of a 34-Year Follow-up.

A coronally advanced flap combined with a subepithelial connective tissue graft is considered the gold standard for achieving root coverage on exposed root surfaces. Nevertheless, challenges arise when this technique is applied to multiple teeth and when the palatal soft tissue is very thin. Several surgical modifications have been reported to simultaneously achieve both single or multiple root coverage and widening of the keratinized gingiva. In this context, there have been no reported cases utilizing the submerged technique with partially de-epithelialized free gingival grafts. We intend to introduce a submerged technique involving partially de-epithelialized free gingival grafts for the modification of soft tissue phenotypes in the maxillary anterior region.

Bone Regenerative Potential of Cross-Linked Collagen Membrane in Peri-Implant Osseous Defect: Case Series with Histologic/Micro-Computed Tomographic Findings.

The role of a barrier membrane is crucial in guided bone regeneration (GBR) for space creation and cell occlusiveness. Those properties of the membrane should be sustained for a sufficient period. For such purpose, several cross-linked collagen membranes were introduced and demonstrated favorable clinical outcomes. However, histologic data were not sufficient to support the effect of cross-linked collagen membranes. In the present case series, healing after GBR using a cross-linked collagen membrane was investigated in-depth via histologic and micro-computed tomographic (micro-CT) analyses. 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide cross-linked collagen membrane was used in GBR for treating various peri-implant bone defects in seven patients. After 4-7 months of healing, newly formed tissue of hard consistency was observed over the implant platform. This tissue was carefully harvested and assessed. In micro-CT and histological analyses, evident new bone formation was revealed, especially in the vicinity of the collagen membrane. Moreover, it was histologically found that some newly formed bone was in intimate contact with the membrane. Although the exact mechanism of bone regeneration in the present cases was not clearly elucidated, the cross-linked collagen membrane appeared to contribute to ossification in GBR. Further studies are needed to confirm the findings of the present case series.

Successful Management of Apically Exposed Implants in the Maxillary Sinus and Associated Sinus Pathologies Via Maxillary Sinus Floor Augmentation.

One common complication with dental implants placed in the atrophic posterior maxilla, especially with simultaneous transcrestal sinus augmentation, is the implant protruding into the sinus without apical bone support. Frequently, apically exposed implants contribute to various sinus pathologies that may lead to implant failure. Treatment options include (1) managing asymptomatic sinus pathology; (2) regrafting the apically exposed portion of the implant(s); and (3) removing the implant and placing a new implant with simultaneous grafting. The purpose of this case report is to present 4 clinical cases of apically exposed implants in the maxillary sinus. The report will cover: (1) exposed implants with asymptomatic sinus pathologies and (2) show successful management of protruding implants and pathologies using maxillary sinus floor augmentation. Various methods of implant surface detoxification, mechanical and chemical, are described for predictable bone remodeling around existing implants as well as newly installed implants. After 6 months of healing, osseointegration was well achieved for all implants and sinonasal complications were not observed. Clinical photographs and 3-dimensional imaging of surgical sites were used to validate clinical assessments.

Endodontic sealer-induced maxillary sinusitis: intraoral surgical approach and implant placement at a site of failed nasal endoscopic surgeries.

A 28-year-old male patient was referred from an otorhinolaryngologist for managing unilateral chronic maxillary sinusitis (MS). The patient had undergone two functional endoscopic sinus surgeries (FESS), although the MS was not resolved. Based on his dental history, endodontic treatment had been done on the symptomatic area. A leak of endodontic sealer and peri-apical lesion on tooth #14 was found on cone-beam computed tomographic examination. Extraction of tooth #14 and the modified Caldwell-Luc operation were performed to remove the endodontic sealer material and relevant inflammatory tissue. The sinus membrane lining was maintained as much as possible during the surgery. Implant placement was performed on the tooth extraction site. All clinical symptoms disappeared after the surgery. Radiographic and endoscopic examination revealed successful osseointegration of the implant and complete resolution of the MS. FESS alone may not be sufficient to treat MS derived from dental origin. For unilateral MS, dental history should be carefully checked.

Tomographic Imaging of Mucociliary Clearance Following Maxillary Sinus Augmentation: A Case Series.

Mucociliary clearance (MCC) allows ventilation of graft particles that are displaced through a perforated Schneiderian membrane during maxillary sinus augmentation (MSA). However, it is very rarely confirmed by cone-beam computed tomographic (CBCT) images. It is not yet known how long the dislodged bone graft particles remain in the maxillary sinus or how quickly they are ventilated after MSA. The purpose of these case reports is to introduce tomographic imaging of ventilation of bone graft particles displaced through a perforated Schneiderian membrane after MSA. Four patients, who needed implant placement in the posterior maxilla, received MSA, during which the Schneiderian membrane was perforated but was not repaired. Therefore, some bone graft particles were dislocated into the sinus cavity. The sizes of the perforated membranes were measured and recorded. CBCT scans were taken at multiple time points after the surgery to visualize and trace the ejected material. In addition, the time from when the bone graft substitute was delivered to the sinus until the CBCT scans were taken was recorded. The expelled bone graft particles migrated to the ostium along the sinus wall immediately after MSA on CBCT images taken immediately after the surgery. No displaced graft particles were observed in the maxillary sinus on CBCT scans after 1 week. The CBCT scans at 6 months showed no unusual radiographic images. Within the limitations of the case reports, tomographic imaging revealed an MCC system that allows displaced graft particles to be ventilated into the ostium very early during MSA healing and not stagnate in the maxillary sinus.

Use of a Lateral Sinus Bony Window as an Intraoral Donor Site for Guided Bone Regeneration in Wide Post-Extraction Defects.

Maxillary sinus augmentation (MSA) and guided bone regeneration (GBR) have shown successful clinical, radiological, and histological outcomes for implant-related bone reconstruction and have been used to augment bony defects of various shapes and sizes. This study demonstrated that the lateral sinus bony window obtained during MSA can be used as an autogenous block bone graft for the augmentation of wide post-extraction defects. During the uncovering procedure performed 6 months after surgery, the grafted lateral bony window was well integrated with the adjacent native bone, and complete bone filling was observed in all bony defects around the implants. All of the implants survived. Within the limitations of this study, autogenous block bone obtained from lateral window sites can be used as novel donors for the resolution of wide bony defects around implants.

Flap Extension Technique Using Intrasocket Granulation Tissue in Peri-Implant Osseous Defect: Case Series.

A compromised extraction socket is characterized by severe bone resorption around neighboring teeth and is often occupied with thick intrasocket granulation tissue (IGT). Guided bone regeneration (GBR) is a procedure that can preserve the bone volume around extraction sockets, and it can also be combined with immediate implant placement. However, an early exposure of GBR sites is a possible complication because it increases the risk of infection and can inhibit successful bone regeneration. The purpose of these case series is to introduce a novel, surgical procedure that can prevent the exposure of GBR sites by using IGT for flap extension during immediate implant placement in compromised extraction sockets. The technique was successfully performed in six patients. For successful flap closure, the inner portion of the IGT was dissected so that the flap was properly extended with the base of IGT attached to the flap for blood supply. Periosteal releasing incisions were not performed. The IGT was first sutured to the palatal flap with resorbable sutures, and then the overlying flap was closed with additional sutures. There was no post-operative exposure of the surgical GBR site in any of the patients, and the location of the mucogingival junction remained unchanged. All grafted sites also achieved sufficient bone regeneration. Within the limitations, this case series demonstrates the potential use of IGT, a concept which was previously obsolete.

Large Grafting Void Resembling a Surgical Ciliated Cyst following Maxillary Sinus Augmentation. Four Case Reports with Histological Observation.

The cause and pathogenicity of grafting voids following lateral maxillary sinus augmentation (MSA) have not yet been elucidated. The first purpose of this case series is to introduce an unusually large grafting void that radiologically resembles a surgical ciliated cyst (SCC) at the sinus augmented site; the second is to observe the histological findings of these grafting voids. In four patients, MSA was performed using the lateral window technique. An unusually large grafting void appeared on cone-beam-computed tomography (CBCT) taken one week after surgery and except for one patient, there were no clinical symptoms. On CBCT taken six months after surgery, the grafting voids were slightly smaller in size but showed radiographic findings similar to those of SCC. During uncovering, grafting voids were removed through the lateral window site. Histologically, the grafting void was empty or filled with dense connective tissue, and no ciliated columnar epithelium or inflammatory cells were observed. Within the limitations of this case series, the large grafting voids generated after MSA was not converted to SCCs. Rather, they remained scar tissue, which could infringe the sinus bone graft and affect the apical bone support of the implant.

Utilizing Previously Grafted Sinus as Intraoral Donor Site for Successful Augmentation in Peri-Implant Osseous Defect: A Case Report.

The purpose of this case report is to introduce a novel guided bone regeneration (GBR) technique that utilized bone harvested from previously grafted maxillary sinus with deproteinized bovine bone mineral (DBBM) 16 years ago. The patient is a 63-year-old male with hopeless maxillary right molars due to severe bone loss. Two months after the extraction, two bone blocks were harvested with a trephine drill from the lateral wall. One was used for histologic analysis and the other was crushed into particulate forms, which was used for a GBR procedure around an implant at the time of implant placement. The grafted site was then covered with a resorbable collagen membrane. The histological specimen showed newly-formed bone containing residual DBBM particles. The DBBM in the harvested bone was mostly resorbed; DBBM particles comprised only 3.6% of the total bone volume. The final prosthesis was delivered six months post-operatively. No change in crestal bone around the implant was observed throughout the 2 year follow-up period. Within the limitation of the present case report, previously grafted sinus can be a good donor site for further harvesting for a successful GBR procedure.

Radiographic and Nasal Endoscopic Observation of Accidentally Perforated Anterior Nasal Cavity With Dental Implants: Case Reports with 5-23 Years of Follow-Up.

Severe atrophy of the maxillary anterior region may make implant placement difficult and, as a result, iatrogenic complications such as nasal floor perforation may occur. The purpose of the present case reports is to present radiographic and nasal endoscopic features in the anterior nasal floor when dental implants were inadvertently perforated into nasal cavities. Between 1996 and 2018, 4 patients recorded with anterior nasal floor perforation with dental implants were followed and reviewed with panoramic radiographs and cone-beam computerized tomography. Also, nasal endoscopic examinations were performed by one otolaryngologist. Four implants in 4 patients were included in this case report. All implants achieved osteointegration and survived for 5-23 years without clinical complications. Three implants did not show any mucosal thickening and only one had minor mucosal thickening as visible on the radiographs. Nasal endoscopy examinations revealed that 3 implants were covered with mucosa and one had threads exposed. Intraorally, only one had clinical signs of peri-implant mucositis. Dental implants that perforated into the anterior nasal floor did not show clinical, radiographic, and nasal endoscopic complications during the long-term follow-up period. Nasal endoscopy was a better diagnostic tool to evaluate the implants perforated into the nasal cavity than conventional panoramic or cone-beam computerized tomography.

Successful Management of Dental Implants in Postoperative Maxillary Cyst: A Case Report With a 13-Year Follow-Up.

The report is presenting a case of implant placement in the postoperative maxillary cyst (POMC) with a follow-up of 13 years. The POMC is a complication associated with various surgical interventions involving maxillary sinus diseases such as Caldwell-Luc operation, orthognathic surgery, and sinus grafting procedures. The lesion of POMC is believed to develop as a result of the changes of ciliated cells or the blockage of ostia inside the maxillary sinus. Two dental implants were placed near the lesion that was later confirmed to be POMC. Of the 2 dental implants placed, one was explanted and the other was successfully managed with surface debridement followed by guided bone regeneration. The removed specimen inclusive of the implant and surrounding tissue was evaluated with clinical photographs, radiographs, and histology and the findings are described in the paper.

Dental Implant Therapy on a Patient With von Willebrand Disease: A Case Study.

BACKGROUND: Von Willebrand disease (vWD) is the most common hereditary disorder affecting coagulation. Patients with this disorder are at a higher risk of postoperative complications after dental surgery. This article discusses the successful treatment for a patient with vWD undergoing implant therapy. CASE DESCRIPTION: A young 21-year-old patient with vWD lost tooth #30 because of caries and required implant therapy. Through collaboration with a hematologist administering prophylactic desmopressin (DDAVP), the implant surgery was performed without any postoperative complications. The implant successfully integrated and was restored into function. The successful outcome met expectations after careful planning and execution. PRACTICAL IMPLICATIONS: Collaboration with the appropriate medical providers, as well as treatment modifications for surgical procedures during implant therapy, is necessary for successful treatment of a patient with von Willebrand disorder.