Facial implant gingival level and thickness changes following maxillary anterior immediate tooth replacement with scarf-connective tissue graft: A 4-13-year retrospective study.

OBJECTIVE: A scarf-shaped connective tissue graft can be placed at the facial and proximal aspect of the peri-implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf-connective tissue graft (S-CTG) in conjunction with IIPP procedures in the esthetic zone. MATERIALS AND METHODS: Patients who received IIPP with S-CTG with a minimum 1-year follow-up were evaluated. Mid-facial gingival level (MFGL) change and mid-facial gingival thickness (MFGT) change were measured and compared at the pre-op (T0), IIPP + S-CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow-up appointment (T3). Implant success rate and graft necrosis were also recorded. RESULTS: A total of 22 IIPP and S-CTG procedures in 20 patients were evaluated in the study. After a mean follow-up of 8.2 years (3.9-13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of -0.19 mm (-1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8-3.5 mm]) after a mean follow-up time (T2) of 2.3 years (1-8.6) when compared with MFGT at baseline (1.1 mm [0.6-1.3 mm]) (T1). Necrosis of S-CTG during initial healing phase was noted in 9% (2/22) of the sites. CONCLUSIONS: Within the confines of this study, scarf-connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone. CLINICAL SIGNIFICANCE: Managing the soft tissue zone is as important as that of the hard tissue zone for peri-implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf-CTG technique is an effective treatment modality to maintain soft tissue stability.

The effect of implant macrogeometry in immediate tooth replacement therapy: A case series.

The concept of immediate tooth replacement therapy (ITRT) in the esthetic zone has become a viable treatment modality and widely accepted in clinical practice. However, achieving adequate primary stability that enables immediate provisional restoration and desirable space for bone-grafting with conventional tapered body implant designs is challenging. The macro-hybrid implant design with a prosthetic angle correction and body-shift feature in a singular form provides not only greater primary stability of a wider diameter implant but also circumferential gap distance both facially and interproximally preserve the labial bone plate and interdental attachment apparatus of the adjacent natural teeth thereby maintaining the interdental papilla. The present clinical series exemplifies the clinical advantages of this inverted body-shift implant design in ITRT in various clinical scenarios in (1) single tooth replacement in a Type 1 intact socket with a thin periodontal phenotype, (2) single tooth replacement in a Type 2 socket with a dentoalveolar dehiscence of the labial bone plate, and (3) multiple adjacent teeth replacement of two maxillary central incisor. CLINICAL SIGNIFICANCE: The macro-hybrid design implant with a prosthetic angle correction and body-shift feature in a singular form provides greater midfacial gap distance as well as tooth-to-implant distance to preserve the interdental attachment of the adjacent natural teeth thereby leaving the interdental papilla undisturbed, without sacrificing higher primary stability afforded by larger diameter implants.

Chairside technique for addition of teeth to an acrylic partial denture. A clinical report.

This article describes a chairside technique of addition of teeth to a patient's existing acrylic partial denture at the extraction appointment without the need for dental laboratory intervention. This maintains aesthetics, function, phonation, biologic integrity, patient confidence, and psychological well-being. An immediate denture is any fixed or removable dental prosthesis fabricated for placement immediately after the removal of a natural tooth/teeth [1,2]. Immediate dentures have many advantages over conventional dentures including conservation of patient's integrity, aesthetics, functionality, soft tissue support and occlusion [2-4]. Immediate dentures require several visits with associated costs and the patient has a period of adjustment to the new prosthesis. This clinical report describes a simple and fast technique of chairside immediate tooth addition to an existing denture avoiding some of these issues.

Acrylic tooth splint-An immediate provisionalisation following tooth extraction; a series of case reports.

Key Clinical Message: Numerous techniques for provisionally replacing a single tooth at the aesthetic zone while planning for future dental implant placement, while soft and hard tissues heal, are critical in restorative treatment strategy. The available materials, simplicity, cost, and impact on the potential implant location should be considered when evaluating the treatment choices. Abstract: Replacement of a single anterior tooth in the aesthetic zone while planning for future implant placement is crucial to the restorative treatment plan. Several methods exist for immediate provisionalisation of the extracted tooth while waiting for soft and hard tissue healing. Although there's a myriad of possible provisionalisation methods available, each option has its advantages and disadvantages. The treatment options should weigh various factors such as the available materials, ease of fabrication, costs, and the effect on the future implant site. This article describes three clinical cases demonstrating a simple yet cost-effective technique to temporarily replace an extracted single anterior tooth, enhancing patient satisfaction and increasing compliance before receiving the definitive implant restoration. The pro and cons for each treatment option available as opposed to the technique involved in the three cases used are also described.