Thermal Testing of Titanium Implants and the Surrounding Ex-Vivo Tissue Irradiated With 9.3um CO2 Laser.

PURPOSE: To measure the temperature rise and surface damage of titanium dental implants and the surrounding tissue in a pig jaw during 9.3-µm carbon dioxide (CO2) laser irradiation at various durations of time. MATERIALS AND METHODS: Thermal analysis tests were performed on 12 implants with the same surface. Twelve implants mounted alone or in pig jaws were laser-irradiated with a 9.3-µm CO2 laser using 3 different power settings. The temperature of the implant body and the proximal tissues was measured with a J-Type Thermocouple after being laser-irradiated with 3 different power setting for 30, 60 seconds, and 2 minutes. Scanning electron microscope (SEM) and digital microscope images were also taken of the all the implants before and after laser irradiation to detect the presence or absence of surface damage. RESULTS: Temperature analysis showed that in all cases the implant and the proximal tissue temperatures remained around the start temperatures of the implant and tissues with fluctuations of ±3°C but never reached the upper threshold of 44°C, the temperature at which thermal injury to bone has been reported. Digital and SEM images that were taken of the implants showed an absence of surface damage at the cutting speed of 20% (0.7 W); however, cutting speeds of 30% to 100% (1.0-4.2 W) did yield surface damage. CONCLUSIONS: Laser irradiation of titanium implant surfaces using a 9.3-µm carbon dioxide laser with an average power of 0.7 W showed no increase in thermal temperature of the implant body and tissue temperatures as well as no evidence of implant surface damage.

Epicrestal and subcrestal placement of platform-switched implants: 18 month-result of a randomized, controlled, split-mouth, prospective clinical trial.

OBJECTIVES: To evaluate the changes in marginal bone levels (MBL) and soft tissue dimension around platform-switched implants with the implant-abutment junction (IAJ) placed at the crest or 1.5-2 mm subcrestally. MATERIALS AND METHODS: In all, 96 platform-switched implants were placed in either the posterior maxilla or mandible in 48 partially edentulous patients in a split-mouth study. All implants were provisionally restored after 4-5 months and definitively after 6 months (T6). Radiographic assessment of MBL was assessed at implant placement (T0), T6, 12 months (T12), and 18 months (T18) after placement. Mid-buccal soft tissue and papilla measurements were performed at T6, T12, and T18. RESULTS: In all, 43 patients with 86 implants completed the study. The T18 examination showed an implant survival rate of 100% in both groups. Analysis showed that MBL varied as a function of IAJ location, which indicated more coronal bone levels with subcrestal (2.39 ± 0.08 mm) than with epicrestal placements (0.88 ± 0.08 mm) (p < .05). Greater average marginal bone loss was found in the subcrestal group (0.40 ± 0.07 mm) compared to the epicrestal group (0.13 ± 0.08 mm) although no statistically significant difference was found at T18 (p > .05). Levels of mid-buccal soft tissue had no significant changes over time, regardless of group (p > .05). There was a significant difference in increase in papilla between T6 and T12 and T18 (p = .005 and .001), but not between T12 and T18 (p = .61). These papilla levels and changes were similar between groups (p > .05). CONCLUSIONS: The MBL changes around platform-switched implants with same geometry were not affected by the epicrestal or subcrestal location of the IAJ. Furthermore, the location of the IAJ did not affect the implant survival and soft tissue dimensions. However, no bone loss was located apical to the IAJ when the implants were placed subcrestally.

Long-Term Implant Survival After 100 Maxillary Sinus Augmentations Using Plasma Rich in Growth Factors.

PURPOSE: To identify determinants of long-term implant survival after sinus augmentation procedure (SAP) using a combination of plasma rich in growth factors (PRGF) and graft material. MATERIALS AND METHODS: Patients were included in this retrospective study if they underwent SAP through a lateral wall approach using PRGF in combination with mainly xenograft, and received implants restored for at least 1 year. Sociodemographic, behavioral and implant characteristics (clinical factors, implant details, surgical details, prosthesis details, and complications) were analyzed. RESULTS: Sixty-seven patients received 217 implants in 100 augmented sinuses. The mean follow-up was 7.2 years. Overall, 22 implants failed in 15 patients (90% cumulative implant survival). Multivariable models showed greater implant survival with implants placed with ≥5 mm of residual crestal bone height (RBH) compared with those placed with <3 mm of RBH. There was also an improvement in survival comparing implant lengths. In addition, immediate loading of implants significantly increased the risk of implant failure. CONCLUSION: The use of PRGFs for maxillary sinus grafting may be an effective and safe treatment option for the rehabilitation of atrophic edentulous posterior maxillae. However, randomized clinical trials are needed to confirm these findings.

The use of 3D models to improve sinus augmentation outcomes - A case report.

Sinus augmentation is a predictable procedure that is often required when restoring the posterior maxilla with dental implants. Even with high success rates, careful pre-surgical planning is crucial. A 3D model is a valuable aid for the clinician as it allows for pre-operative simulation, which can reduce surgical time, reduce the risk of intra-operative complications and decrease the potential for error. The aim of this case report is to focus on how such a model is useful when undertaking a sinus augmentation procedure with simultaneous implant placement.

Successful Surgical Protocols in the Treatment of Peri-Implantitis: A Narrative Review of the Literature.

BACKGROUND: The aim was to identify and evaluate those surgical protocols reporting on positive clinical outcomes for treating peri-implantitis with 12 or more months of follow-up. Method of surface decontamination (SDC) was evaluated for any correlation with outcomes. RESULTS: A literature search was performed of all articles published in English between January 1, 2001 and April 30, 2015. Of the 639 identified, 26 satisfied the inclusion criteria. Outcomes reported on included reductions in bleeding on probing (BoP) and probing depth (PD), mean radiographic bone fill (RBF), and mean change in marginal soft tissue levels (MR±). Methods of SDC included mechanical debridement (MD) with and without saline use, MD plus laser or photodynamic therapy, MD with air powder abrasion, MD with chemotherapeutic implant surface decontamination, and combination approaches. The results suggested that various methods of SDC were effective. Heterogeneity of the studies made it impossible to determine correlations between clinical outcome and SDC method. Most studies over 12 months reporting better treatment outcomes employed a bone replacement. Additionally, studies where patients with periodontitis were treated before their peri-implantitis care also had better outcomes. CONCLUSION: The current review failed to reveal any correlation between any particular method for SDC or defect treatment protocol and positive clinical outcomes. Further comparative studies are warranted to determine the most appropriate approach for both of these topics.

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.

A Less-Invasive Window Design for Lateral Wall Maxillary Sinus Augmentation for Single Implants.

Maxillary sinus window design is an important factor in sinus augmentation procedures, playing a key role in managing maxillary sinus elevation complications, avoiding the sinus septum, and providing lateral support for the graft material. A less-invasive window design in comparison to conventional maxillary sinus windows was introduced with an "I"-shaped window for single implant placement. However, drawbacks of this window design have included limited instrument accessibility to the anterior sinus and incomplete membrane elevation. The purpose of this case report is to demonstrate a step-by-step surgical procedure for lateral wall maxillary sinus augmentation with a novel "J"-shaped window design for single implants.

Clinical Advantages of Implant Osteotomy through the Remaining Root in Mandibular Premolar Region.

The placement of a dental implant by creating the osteotomy through the remaining root can serve as a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures such as the mental foramen and inferior alveolar nerve in close proximity to the planned osteotomy, and facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area.

A Modified Socket-Shield Technique: Simplifying the Root Sectioning Process.

Socket wall resorption leading to a loss of surrounding bone following tooth extraction has been documented in the dental literature. The use of various socket-shield techniques has been suggested as a solution to this issue. In these approaches, the tooth root is sectioned in two, and the coronal two-thirds of the buccal root is preserved in the socket. This allows the periodontium along with the bundle and buccal bone to remain intact, thus preventing or minimizing bone remodeling. According to the literature, this procedure is highly technique sensitive, especially when it comes to sectioning the root. Additionally, the procedure requires significant time, and several complications may occur, such as fenestration or luxation of the remaining root, requiring its complete extraction. This case report presents a modified socket-shield technique using a trephine bur guided by a computer-designed surgical guide to simplify root sectioning, thus reducing surgical time while increasing predictability of the outcome.

Successful Implant Placement into a Site with Two Previous Failures: A Clinical and Histologic Case Report.

Implants present a predictable fixed option for patients who require tooth extraction. However, complications such as implant failure reduce the success of replacement implant restorations. A patient presented to the Department of Periodontology and Implant Dentistry (New York University College of Dentistry) with pain related to a broken implant-supported prosthesis. Two failed implants were removed, and new implants were placed. After restoration delivery, the patient reported soreness on the implant at site 35 (FDI tooth-numbering system), which was then removed (along with a sequestrum of bone) and sent for biopsy. A new implant was placed and restored successfully at the 1-year follow-up. The purpose of this case report is to demonstrate that with proper planning, surgery, and restoration, a new implant can be successfully placed and restored on a site with two previous failures. Int J Periodontics Restorative Dent 2023;43:167-172. doi: 10.11607/prd.5410.

The Custom Alveolar Ridge Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Posterior Mandible: A Case Report.

The Custom Alveolar Ridge Splitting (CARS) technique was recently reported as a less-invasive treatment option for augmentation of the maxillary anterior area in cases where alveolar width deficiency exists due to bone resorption and remodeling. This technique creates an intraosseous defect to improve success when horizontal ridge augmentation is attempted. The purpose of the present case report was to demonstrate implant placement in an atrophic posterior mandibular site using the CARS technique. This technique was used in the mandibular right second premolar area, followed by placement of a single implant. The restored implant showed stable soft and hard tissue outcomes at 6 months postloading.

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.

Treatment of a Soft Tissue Depression with a Xenograft Bone Substitute at the Second Stage of an Implant Procedure: A Case Report.

Following the extraction of a compromised tooth, the edentulous alveolar ridge undergoes physiologic bone remodeling, which may create a bone volume too deficient for implant placement. Guided bone regeneration (GBR) provides a predictable treatment option to increase the alveolar bone volume for implant placement, but a soft or hard tissue deficiency may remain even after this augmentation procedure has been completed. These deficiencies can be especially challenging in the esthetic zone, where patient expectations and esthetics often determine the satisfaction of the treatment outcome. This paper presents a case report of a xenograft bone substitute used at the second-stage surgery and abutment insertion to provide a solution to these deficiencies even after the patient had undergone a GBR procedure, thus improving the esthetic and functional outcomes of the final implant-supported restoration.

The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Maxillary sinus elevation by lateral window approach: evolution of technology and technique.

CONTEXT: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. EVIDENCE ACQUISITION: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. EVIDENCE SYNTHESIS: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. CONCLUSIONS: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.

A Narrative Review of the Diagnosis, Etiology, and Treatment of Halitosis Over the Past Three Decades.

Although the term "halitosis" was first coined in 1874, people have become increasingly aware of this problem more recently during the COVID-19 pandemic due to extensive wearing of protective masks. In fact, following dental caries and periodontal disease, halitosis is the third most prevalent reason for patients going to the dentist. Due to multifactorial etiology, the diagnosis of halitosis requires a rigorous health/dental/social history, a clinical examination, and measurements. The treatment ranges from the use of dentifrices, mouthwashes, tongue scraping, and masking products, and more recently includes photodynamic therapy, probiotics, and ozone. The purpose of this narrative review was to examine the published literature concerning halitosis over the past 30 years and discuss the diagnosis, etiology, and treatment of the disease.

Regenerative Treatment of Advanced Peri-implantitis: A Retrospective Case Series with 3 to 15 Years of Follow-up.

The present case series evaluated implant survival and changes in bleeding on probing (BOP), probing depths, marginal tissue levels (recession), and bone levels following regenerative treatment of implants with advanced peri-implantitis. Forty-six implants with advanced peri-implantitis in 38 patients were treated with a regenerative protocol and evaluated for the above parameters at the final follow-up 3 to 15 years later. Patients returned every 2 to 3 months for maintenance and at the final evaluation. Measurements were made and compared to those recorded preoperatively. No implant was lost, BOP was reduced to 0 on all but 4 implants, the mean reduction in pocket depth was 6.7 mm, and the average soft tissue marginal position was 0.9 mm coronal to presurgical levels. Bone level changes showed a mean gain of 3.6 mm (radiographically) and 6.8 mm (bone sounding). These results appear to indicate that an implant with > 50% bone loss caused by peri-implantitis can successfully be treated and retained using a specific regenerative technique.

A Revised Peri-implantitis Classification Scheme: Adding Three-Dimensional Considerations to Facilitate Prognosis and Treatment Planning.

Historically, diagnosing peri-implantitis is done based on whether the disease is present, evaluated using the arbitrary thresholds of probing depths and bone loss. Using this approach as a tool to ascertain meaningful information regarding prevalence and treatment is limited. Efforts have been made to improve upon this, but to date, only one of these classifications has provided a simple method to communicate disease severity based on the amount of bone loss. A modified version of this simplified classification is proposed here, including information regarding the implant position, as emerging information suggests that this is a crucial factor in the etiology and prognosis of peri-implantitis. This enhancement to the classification better serves both researchers and clinicians in their discussion about peri-implantitis and helps to determine and recommend the most effective methods of management.

Long-term Results of Maxillary Full-Arch Reconstruction Using Transitional Implants: A Case Report With 20-Year Follow-up.

Because of their documented long-term success rates, dental implants have become a predictable treatment option to replace hopeless or missing teeth. However, full-arc transition from a hopeless dentition to a prosthesis supported by dental implants remains a challenge. One treatment option for this process is the use of transitional implants, an approach that allows for the transitioning of full-arch reconstructions from teeth to implant-supported prostheses without immediate loading the permanent implants or the need for provisional removable partial dentures. This article, which presents a long-term clinical case report, describes the steps and sequence of therapy involved in transitioning from a hopeless dentition to a maxillary full-arch implant-supported fixed prosthetic rehabilitation with the use of transitional implants, avoiding removable provisional prostheses. An assessment of the 20-year follow-up, dental implant survival rates, and marginal bone loss is also presented.

Repair of a Non-Retentive Crown Over a Press-Fit Implant Placed 30 Years Prior: A Case Report.

Dental implant treatment has been proven to be a successful therapy to rehabilitate single, partial, and fully edentulous sites. Evidence shows that the use of implant-supported restorations is predictable and can deliver long-term success. However, discontinuation of implant systems can be challenging for prosthesis maintenance. In this case report, a 70-year-old female patient presented to the implant department at New York University College of Dentistry with a press-fit implant with a one-piece cementable abutment that was placed more than 30 years prior. The patient's chief complaint was that the crown kept falling off. Upon evaluation, it was found that the implant was well-integrated in bone with no signs of infection. Explantation and replacement of the well-integrated implant was not considered the best option. An alternative approach was to address the retention of the abutment. The purpose of this case report is to demonstrate an intraoral technique for fabricating a custom cement-retained crown over a non-retentive one-piece press-fit implant.