The esthetic dental implant: letting restoration be the guide

Top-down design and fabrication with digital technology of removable partial dentures incorporating custom abutments: A dental technique

A novel design of removable partial dentures (RPDs) is described wherein custom abutments are incorporated into the RPD framework. The artificial teeth and custom abutments are designed by using a computer-aided design (CAD) software program. Subsequently, the RPD framework is designed and merged to the custom abutments in the CAD software program to form a single unit. This modified framework is additively manufactured in metal by using a 3D printer. Thereafter, the framework is adapted to the definitive cast and scanned by using a laboratory scanner. The scanned file is imported into the CAD software program, and the artificial teeth are redesigned. After fabricating each artificial tooth from a polymethylmethacrylate disk and artificial tooth and denture-base assemblies from a wax disk, the RPD is injection molded. This RPD design and fabrication workflow enables a top-down approach by prioritizing the shape and arrangement of the artificial teeth and facilitates their replacement.

Prevention of peri-implant disease in edentulous patients with fixed implant rehabilitations

OBJECTIVES

To provide an overview about the current approaches to prevent peri-implant diseases in edentulous patients with complete-arch implant-supported prostheses, and to review the clinical applications of the latest digital technologies for implant prosthodontics.

METHODS

A review of the guidelines to prevent peri-implant diseases in patient's receiving complete-arch implant-supported prostheses including facially driven treatment planning procedures using either conventional or digital methods, computer-aided implant planning procedures, and prosthodontic design variables including the optimal number and distribution of dental implants, implant to abutment connection type, implant or abutment level design, screw- or cement-retained alternatives, prostheses contours, and material selection is provided. Furthermore, an outline of the current therapeutic management approaches to address peri-implant diseases is reviewed.

CONCLUSIONS

Clinicians should understand and know different planning and design-related variables that can affect biological and mechanical complication rates of complete-arch implant-supported prostheses. Maintenance protocols are fundamental for minimizing biological and mechanical complications.

[A modified technique for expanding the attached keratinized gingiva zone using a free gingival graft "Danilov`s medallions"]

On a clinical example a modified technique for increasing the width of the attached keratinized gingiva zone is presented by taking medallions of a free gingival graft 1.5-2 mm thick from the hard palate using 5 mm mucotomes and transplanting them into the gum defect zones with a simultaneous vestibular deepening in the lateral regions of the jaws. This technology has been tested over a 5-year period with long-term clinical results.

An In Vitro Study of the Reproducibility of the Drilling Access of Digitalized Surgical Guides Generated via Three Different Implant Planning Software Programs

Several implant planning software programs are widely use in implant treatments, but there has been no evidence of how different software programs affect the accuracy of static surgical guides used for implant placement. Thus, in this in vitro study, we aimed to compare the accuracy of static surgical guides that were prefabricated from three different software programs, including Implant Studio (Program A) (3Shape®, Copenhagen, Denmark), coDiagnostiX® (Program B) (Straumann®, Basal, Switzerland), and Blue Sky Plan (Program C) (Blue Sky Bio®, LLC, Libertyville, IL, USA). A total of 90 drillable polyurethane models were used as samples in this in vitro study; 30 study models were used to plan the same implant positions and design the surgical guides by each software program (n = 30) and then 90 implants were placed in the models using the surgical guides. The outcomes of the surgical guide accuracy were autonomically measured by the evaluation tool in the coDiagnostiX® (Straumann®, Basal, Switzerland) software program. The deviations between the planned and placed implants were automatically evaluated as three-dimensional and angular deviations. The mean three-dimensional implant position deviations from the implant platform of Program A, Program B, and Program C were 0.55 ± 0.25 mm, 0.52 ± 0.31 mm, and 0.56 ± 0.22 mm, respectively. The mean three-dimensional implant position deviations from the implant apex of Program A, Program B, and Program C were 0.72 ± 0.37 mm, 0.73 ± 0.4 mm, and 0.9 ± 0.46 mm, respectively. The mean depth deviations of Program A, Program B, and Program C were 0.19 ± 0.13 mm, 0.31 ± 0.32 mm, and 0.31 ± 0.22 mm, respectively. The mean angulation deviations of Program A, Program B, and Program C were 1.72 ± 0.88 degrees, 2.05 ± 1.24 degrees, and 2.74 ± 1.81 degrees, respectively. The results indicated that there were no significant differences among the three-dimensional positions at the implant platform, the three-dimensional positions at the implant apex, and the depth deviations between all three groups. However, it was found that there was a significant difference in the angular deviation of the implant position between the three groups (p = 0.02). The mean angular deviation of Program C was significantly greater than the Program A group (p = 0.001). In terms of the deviation directions of the implant platform and implant apex for the three groups, most of the deviations of a larger magnitude were toward the mesio-buccal direction. No matter which program was used to plan the implant position, deviations between the placed implant position and the planned position still occurred. Therefore, when planning implant positions with any implant planning software program, one must take into account an implant position deviation.

Transitional Dental implant in Adolescent Patient - A Narrative Review

AIM

This article aims to review the literature available on transitional implants and elaborates on the same through a case report with a follow-up of 5 years.

MATERIAL AND METHOD

PubMed, Medline, Google Scholar, and Web of Science databases were screened for literature. Articles other than those in English language were excluded. For the review, the complete texts of 49 papers were acquired, with 34 of them being included in the review.

CONCLUSION

Transitional implant placement could be considered as an alternative to removable or fixed resin bonded dental prosthesis in adolescents with a regular follow-up. In such patients, a detailed assessment of growth pattern and a prediction of growth completion has to be done before considering implant as a treatment option.

3D Considerations and Outcomes of Immediate Single Implant Insertion and Provisionalization at the Maxillary Esthetic Zone: A Long-Term Retrospective Follow-Up Study of Up to 18 Years

AIM

Long-term studies addressing the outcomes of single immediate implantation and provisionalization at the maxillary esthetic zone are needed. The current study aimed to assess such outcomes along a follow-up period of up to 18 years.

MATERIALS AND METHODS

The current study is a continuation follow-up of our previously published up to 6-year follow-up study, dated between the years 2002-2008, performed in a private clinical practice in Tel-Aviv, Israel. A total of 15 patients (23 implants) who had been treated for single-tooth replacement at the maxillary esthetic zone since 2002, underwent clinical and radiographic follow-up evaluations. Primary outcomes included mean Marginal Bone Levels (MBL), with Bleeding on Probing (BOP), implant success rate, prosthetic and esthetic complications evaluated as secondary outcomes.

RESULTS

The implant success rate was at 100%. Bone remodeling processes were observed over the follow-up period, with 0.9 mm mean marginal bone loss observed during the first 6 years of observation, followed by -0.13 ± 0.06 mm mean loss after 6 to 18 years. The last finding suggests bone deposition, as reported by other studies (Donati et al., 2012). At the final radiographic evaluation, a mean MBL of 1.35 mm ± 0.16 was demonstrated. No differences with respect to implant type or site were found. A generalized absence of BOP and esthetic complications occurred in two cases as a result of continuous adjacent teeth eruption versus obvious implant ankylosis.

CONCLUSIONS

Adhering to careful clinical protocols and 3D bone to implant considerations while immediately placing an anterior implant, this treatment approach offers both stable and esthetically acceptable results for the replacement of missing teeth at the maxillary esthetic zone.

The question about the numerical value and quantitative data transfer of implant prosthodontics-orom experience guidance to digital guidance

The correct implant site design and placement are the basic clinical techniques that must be known for implant restoration. For a long time, most implants have been placed by free hands, and the choice of site is mostly dependent on the accumulation of long-term experience of the surgeon. The selection of implant site guided by this experience analogy logic is often based on the surgeon's level of experience,which often makes it very easy to produce complications related to the implant restoration of the incorrect site. In contrast, a clinical program using digital guidance and real-time measurable verification has emerged based on the restoration-oriented implantation concept, which marks the formation of an accurate, measurable and verifiable whole-process digital implant prototype. Furthermore, from the perspective of surveying, the numerical requirements that digital implant restoration relies on are actually incomplete to the four elements of measurement, which leading to the doubts about its authenticity. This article will question the numbers in implant restoration, and conduct a preliminary demonstration, and propose a new reliable actual measurement and verification method of the correct location and the numerical requirements of the restoration space and a new clinical program that relies on numbers from the perspective of the evolution of digital restoration, guided implantology and actual measurement technology. And this article further discusses the current mainstream implant restoration technology based on experience analogy which cannot effectively support the whole process of digital implant restoration and provides a new logical cognitive basis for the final realization of the entire process of digital implant restoration.

Three-dimensional (3D) facially driven workflow for anterior ridge defect evaluation: a treatment concept

The esthetic rehabilitation of anterior ridge defects and the achievement of patient satisfaction has become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures which fail to meet patient expectations. The loss of hard and soft tissues in esthetic compromised zone is commonly associated with anterior ridges and affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment planning considering esthetic parameters, prosthetic needs, and morphological defects must be conducted to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects focusing on digital evaluation systems and guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for the esthetic outcomes and the treatment alternatives for anterior ridge defects are also addressed.

Accuracy of high-resolution ultrasound (US) for gingival soft tissue thickness mesurement in edentulous patients prior to implant placement

OBJECTIVES

To evaluate and compare the accuracy of high-resolution ultrasound (US) with two different cone beam CT (CBCT) units and clinical assessment for measuring gingival soft tissue thickness in edentulous patients prior to implant placement.

METHODS AND MATERIALS

The study consisted of 40 maxillary implant sites of 40 healthy patients (20 females, 20 males; mean age, 47.88 years). We prospectively evaluated labial/buccal gingival thickness in 40 implant regions (16 anterior and 24 posterior) by using limited field of view (FOV) CBCT images and US images in comparison to gold standard transgingival probing measurements. One-way analysis of variance (ANOVA) was used to compare mean measurements obtained from CBCT (Morita and Planmeca), US, and transgingival probing. Interclass correlation coefficient (ICC) estimates were calculated based on means with two-way mixed and absolute-agreement model. Bland Altman plot was used to describe agreement between clinical vs US and CBCT measurements by constructing limits of agreement. Statistical significance was set at p < 0.05.

RESULTS

There was no significant difference between methods used according to mean gingival thickness measurements obtained from the top (p = 0.519) and bottom (p = 0.346) of the alveolar process. US and CBCT measurements highly correlated with clinical measurements for both top and bottom alveolar process gingival thickness (p < 0.001). Distribution of differences between clinical measurements and both CBCT measurements showed statistically significant differences according to 0 (p < 0.05). Distribution of differences between clinical measurements and US measurements did not show statistically significant difference (p > 0.05).

CONCLUSION

High-resolution US provided accurate information for the measurement of gingival soft tissue thickness in edentulous patients prior to implant placement.

Advanced platelet-rich fibrin plus and osseous bone graft for socket preservation and ridge augmentation - A randomized control clinical trial

Objective

To compare the clinical and radiographic effectiveness of A PRF Plus as an adjuctive material to osseous bone graft in socket preservation and ridge augmentation.

Methods

Twenty patients with need to preserve extraction socket in non-molar sites planning for further prosthetic rehabilitation were divided into two groups. Test Group (Group A) was treated with A PRF Plus membrane and Sybograf plus ™ (70% HA and 30 %β TCP) bone graft. The Control Group (Group B) was treated with Sybograf plus ™ (70% HA and 30% βTCP) bone graft. Both groups had same socket preservation surgical technique.

Results

Both Group A and Group B showed significant improvement in clinical and radiographic parameters. Mean socket length, Vertical Resorption reduction in Group A was 1.48 whereas in Group B was 1.67 which is statistically significant. (p ​≤ ​0.05). Changes in Horizontal width reduction at 1,3, and 5 ​mm depth of the socket for both groups were not statistically significant. The Gain in socket fill for Group A and B 6 months postoperatively was 1185.30HU ± 473.21 and 966.60 HU ± 273.27 respectively. But intergroup comparison was not statistically significant. (p ​= ​0.17). There were no significant statistical differences in postoperative pain in Group A and Group B as subjects experienced moderate amount of pain. The assessment of post-operative swelling showed that only 30% subjects in Group A reported with swelling. Whereas 80% subjects in Group B complained of post-operative swelling.

Conclusion

The results of the present study proved utilisation of A PRF Plus as a promising adjunct to conventional regenerative therapy for socket preservation.

Predictable immediate implant placement and restoration in the esthetic zone

This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.

Errors in Implant Positioning Due to Lack of Planning: A Clinical Case Report of New Prosthetic Materials and Solutions

The achievement of the optimal implant position is a critical consideration in implant surgery, as it can facilitate the ideal prosthesis design and allow adequate oral hygiene maintenance. The switch from bone-driven to prosthetic-driven implant placement, through a comprehensive diagnosis and adequate treatment plan, is a prerequisite for long-term successful implant-based therapy. The aim of the present case report is to describe a step-by-step prosthetic retreatment of a patient with primary treatment failure due to incorrect dental implant placement. Although dental implants achieve high survival rates, the success of implant prosthetic therapy significantly relies on an appropriate implant position. Malpositioned implants can cause damage to vital structures, like nerves or vessels. Moreover, improper implant positioning can result in esthetic, biological, and technical complications and can, in extreme situations, render the desired prosthetic rehabilitation impossible to achieve.

Factors Influencing the Presence of Papilla between Adjacent Implants and between a Tooth and an Implant

Aim

The aim this study was to evaluate the factors that influence the presence or absence of the interproximal papilla between implants adjacent to the teeth or other implants, through clinical and radiographic evaluation.

Material and Methods

The non-probabilistic sample comprised 44 patients of both genders aged between 21 and 68 years, rehabilitated with 114 osseointegrated implants. Through a retrospective clinical study, the patients were divided according to the presence or absence of the interproximal papilla: Group 1 - Absence of Papilla, Group 2 - Partial Presence of Papilla and Group 3 - Total Presence of Papilla. The success of the implants, the periodontal biotype, and the vertical and horizontal distances of the interproximal regions included in the study were evaluated.

Results

Of the 114 implants, 46.5% were considered unsuccessful, and bleeding was present in 29.8%. The periodontal biotype presented as thin and scalloped was found in 85.1% of the regions. The evaluation of the groups according to the confirmation of the interproximal space showed a statistically significant difference (p = 0.007), with 61.9% of the wide and long interproximal spaces classified as Group 1, while 31% of the narrow and short interproximal spaces were classified as Group 3.

Conclusion

It was concluded that the morphology of the interproximal space was the factor that was most strongly associated with the presence or absence of the interproximal papilla.

Evolution of Aesthetic Dentistry

One of the main goals of dental treatment is to mimic teeth and design smiles in a most natural and aesthetic manner, based on the individual and specific needs of the patient. Possibilities to reach that goal have significantly improved over the last decade through new and specific treatment modalities, steadily enhanced and more aesthetic dental materials, and novel techniques and technologies. This article gives an overview of the evolution of aesthetic dentistry over the past 100 y from a historical point of view and highlights advances in the development of dental research and clinical interventions that have contributed the science and art of aesthetic dentistry. Among the most noteworthy advancements over the past decade are the establishment of universal aesthetic rules and guidelines based on the assessment of natural aesthetic parameters, anatomy, and physiognomy; the development of tooth whitening and advanced restorative as well as prosthetic materials and techniques, supported by the pioneering discovery of dental adhesion; the significant progress in orthodontics and periodontal as well as oral and maxillofacial surgery; and, most recently, the implementation of digital technologies in the 3-dimensional planning and realization of truly natural, individual, and aesthetic smiles. In the future, artificial intelligence and machine learning will likely lead to automation of aesthetic evaluation, smile design, and treatment-planning processes.

Influence of the anterior arch shape and root position on root angulation in the maxillary esthetic area

Purpose

This study was conducted to characterize the relationship of the angulation between the tooth root axis and alveolar bone axis with anterior alveolar (AA) arch forms and sagittal root position (SRP) in the anterior esthetic region using cone-beam computed tomography (CBCT) images.

Materials and Methods

CBCT images that met the inclusion and exclusion criteria were categorized using a recent classification of AA arch forms and a SRP classification. Then, the angulation of the root axis and the alveolar bone axis was measured using mid-sagittal CBCT images of each tooth. The relationships of the angulation with each AA arch form and SRP classification were evaluated using 1-way analysis of variance and a linear regression model.

Results

Ninety-eight CBCT images were included in this study. SRP had a greater influence than the AA arch form on the angulation of the root axis and the alveolar bone axis (P<0.05). However, the combination of AA arch form and SRP was more predictive of the angulation of the root axis and the alveolar bone axis than either parameter individually.

Conclusion

The angulation of the root axis and alveolar bone axis demonstrated a relationship with the AA arch form and SRP in teeth in the anterior esthetic region. The influence of SRP was greater, but the combination of both parameters was more predictive of root-to-bone angulation than either parameter individually, implying that clinicians should account for both the AA arch form and SRP when planning implant placement procedures in this region.

Implant dentistry in Australia: the present and future. A survey of Australian dentists and specialists

BACKGROUND

In recent years, implant dentistry has become a routine part of many general dental practices in Australia. However, there has been little information regarding its extent and scope. This investigation aimed to address this issue by surveying Australian general dental practitioners (GDP) and relevant specialists regarding their practice of implant dentistry.

METHODS

Anonymous electronic surveys were designed online using SurveyMonkey™ and delivered to the following professional bodies: all seven state/territory branches of the Australian Dental Association, the Australian and New Zealand Academy of Periodontists, the Australian and New Zealand Academy of Oral and Maxillofacial Surgeons, and prosthodontist members of the Australian Prosthodontic Society. The surveys were completed online via SurveyMonkey in 2014.

RESULTS

The response rates were 7.61% (N = 801) for GDP, 41.76% (N = 38) for prosthodontists, 34.16% (N = 55) for periodontists and 34.07% (N = 46) for oral and maxillofacial (OMF) surgeons. Among the respondents, 66.37% (N = 521) of GDP, 86.11% (N = 31) of prosthodontists, 82.98% (N = 39) of periodontists and 97.67% (N = 42) of OMF surgeons indicated that they currently practise implant dentistry. A strong perceived need for further education in this field was also expressed by the respondents.

CONCLUSIONS

Implant dentistry presently appears to be practised by a significant proportion of GDP across Australia. This is likely to continue to grow in the future.

Prosthodontic Considerations in Post-cancer Reconstructions

The restoration of function after oncologic surgery of the oral cavity constitutes one of the major challenges facing head and neck oncology. Within the general objective of securing esthetic as well as functional reconstructions, dental rehabilitation is crucial for achieving a good outcome. Adequate dental rehabilitation allows the patient to chew food and considerably improves speech and swallowing. These reconstructions will be driven biologically or prosthetically following surgical design and outcome.

Guidelines for positioning external hexagon implants in screw-retained multiple prostheses using rotational abutment-type components

PURPOSE

This study measured the maximum angulation between 2 implants allowed by the internal walls of the component in screw-retained multiple prostheses using rotational abutment-type components.

MATERIALS AND METHODS

Thirty specimens of 3 different brands (Conexão; Neodent; and SIN), consisting of titanium rotational abutments connected to external hexagon abutment analogs with standard platforms, were divided into 3 groups. The specimens were internally filled with polyester resin, screw retained, torque, and sectioned to assess the space existing between the internal wall of the rotational abutment component, edge, and vertex of the hexagon. The measurements were performed using 3-dimensional equipment.

RESULTS

When the implant hexagons were oriented edge-to-edge, groups 1, 2, and 3 presented 40.75, 45.00, and 31.89 degrees, respectively. Vertex-to-vertex hexagon orientation showed 9.79, 18.18, and 3.27 degrees for groups 1, 2, and 3, respectively.

CONCLUSIONS

The maximum mean angulation in the mesio/distal direction between the 2 implants with hexagon-oriented vertex-to-vertex is 10.41 degrees, and hexagon-oriented edge-to-edge is 39.54 degrees. This study suggests guidelines for positioning external hexagon implants for interference-free screw-retained multiple prostheses using rotational abutment-type components.

Accuracy of computer-aided template-guided oral implant placement: a prospective clinical study

Purpose

The aim of the present study was to evaluate the in vivo accuracy of flapless, computer-aided implant placement by comparing the three-dimensional (3D) position of planned and placed implants through an analysis of linear and angular deviations.

Methods

Implant position was virtually planned using 3D planning software based on the functional and aesthetic requirements of the final restorations. Computer-aided design/computer-assisted manufacture technology was used to transfer the virtual plan to the surgical environment. The 3D position of the planned and placed implants, in terms of the linear deviations of the implant head and apex and the angular deviations of the implant axis, was compared by overlapping the pre- and postoperative computed tomography scans using dedicated software.

Results

The comparison of 14 implants showed a mean linear deviation of the implant head of 0.56 mm (standard deviation [SD], 0.23), a mean linear deviation of the implant apex of 0.64 mm (SD, 0.29), and a mean angular deviation of the long axis of 2.42° (SD, 1.02).

Conclusions

In the present study, computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected. Therefore, accurate presurgical planning taking into account anatomical limitations and prosthetic demands is mandatory to ensure a predictable treatment, without incurring possible intra- and postoperative complications.

Graphical Abstract

Measurement of gingival thickness using digital vernier caliper and ultrasonographic method: a comparative study

BACKGROUND

The measurement of the thickness of the gingival tissues has been done using different techniques. Trans-gingival probing with a graduated probe, use of vernier calipers, ultrasonography and cone-beam computed tomography (CBCT), have all been tried, but no one technique has been shown to be consistent and better than the others. The present study was done to evaluate and compare the gingival thickness as measured with a digital vernier caliper and ultrasonography.

METHODS

A total of 30 systemically healthy, non-smokers were included in the study. The gingival measurements were made and recorded from the maxillary and mandibular lateral incisor areas at 2 locations: (a) at a point apical to the free gingival groove; and (b) at a point immediately coronal to the muco-gingival junction.

RESULTS

The mean gingival thickness ranged from 0.56 to 1.02 mm. Males had a significantly thicker gingiva as compared to females (P < 0.10). Significant differences were not observed when the measurements made using the digital vernier caliper and those made with ultrasonography were compared.

CONCLUSIONS

The thickness of the gingiva was in the range of 0.56-1.02 mm. A digital vernier caliper and ultrasonography both can be used to assess the gingival thickness with equal accuracy.

Flapless implant surgery: a 2-year follow-up study of 40 implants

OBJECTIVES

Flapless implant surgery is fast gaining popularity because of several advantages, such as reduced surgical time, postoperative bleeding, and swelling. Studies have shown that flap elevation results in some amount of bone loss. The aim of the current study was to compare the amount of bone loss in procedures using the flapless technique and those where flap elevation was done. Papillary fill was also compared in both techniques, which is unique to this study.

STUDY DESIGN

Forty patients, selected according to certain inclusion and exclusion criteria, were randomly assigned to 1 of 2 groups: Flap (F), or Flapless (FL). The amount of crestal bone loss was measured from standardized radiographs at baseline, 6 months, 1 year, and 2 years after implant placement. Papillary fill was evaluated using the Papillary presence index, which was measured 6 months after loading.

RESULTS

The bone loss was greater for the F group during all time periods and the mean papillary fill was greater for the FL group.

CONCLUSIONS

In conclusion, the results of the current study show that flapless implant surgery results in less crestal bone loss both during the healing period and after loading. In addition, it can produce better papillary fill. The cases selected for this study were ideal cases in terms of bone volume and the operator was well experienced, however. Care should be taken during case selection for flapless implant surgery.

Virtual implant planning in the edentulous maxilla: criteria for decision making of prosthesis design

OBJECTIVES

To evaluate prosthetic parameters in the edentulous anterior maxilla for decision making between fixed and removable implant prosthesis using virtual planning software.

MATERIAL AND METHODS

CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Implants (≥3.5 mm diameter, ≥10 mm length) were virtually placed in the optimal three-dimensional prosthetic position of all maxillary front teeth. Anatomical and prosthetic landmarks, including the cervical crown point (C-Point), the acrylic flange border (F-Point), and the implant-platform buccal-end (I-Point) were defined in each middle section to determine four measuring parameters: (1) acrylic flange height (FLHeight), (2) mucosal coverage (MucCov), (3) crown-Implant distance (CID) and (4) buccal prosthesis profile (ProsthProfile). Based on these parameters, all patients were assigned to one of three classes: (A) MucCov ≤ 0 mm and ProsthProfile≥45(0) allowing for fixed prosthesis, (B) MucCov = 0-5 mm and/or ProsthProfile = 30(0) -45(0) probably allowing for fixed prosthesis, and (C) MucCov ≥ 5 mm and/or ProsthProfile ≤ 30(0) where removable prosthesis is favorable. Statistical analyses included descriptive methods and non-parametric tests.

RESULTS

Mean values were for FLHeight 10.0 mm, MucCov 5.6 mm, CID 7.4 mm, and ProsthProfile 39.1(0) . Seventy percent of patients fulfilled class C criteria (removable), 21% class B (probably fixed), and 2% class A (fixed), while in 7% (three patients) bone volume was insufficient for implant planning.

CONCLUSIONS

The proposed classification and virtual planning procedure simplify the decision-making process regarding type of prosthesis and increase predictability of esthetic treatment outcomes. It was demonstrated that in the majority of cases, the space between the prosthetic crown and implant platform had to be filled with prosthetic materials.

A novel surgical template design in staged dental implant rehabilitations

Background

The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning.

Methods

This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts.

Results

This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes.

Conclusions

Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery.

An interdisciplinary treatment approach combining orthodontic forced eruption with immediate implant placement to achieve a satisfactory treatment outcome: a case report

BACKGROUND

Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration-driven positions and deteriorates the success rates for dental implants.

PURPOSE

The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction.

MATERIAL AND METHODS

The subject of this study is a 40-year-old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner.

RESULTS

Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of osteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown.

CONCLUSION

In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.

Use of diagnostic and surgical stent: a simplified approach for implant placement

Dental implantology has emerged as a practical alternative to traditional prosthodontics. Since the beginning, placement of implant in the bone to achieve a prosthetic solution that fulfils biologic, aesthetic and biomechanical requirements has been a challenge. In the past, implant site and inclination were dictated by residual bone quality. The desire for predictable prosthesis led to the development of prosthetically guided implantology. This concept establishes the correct implant position during the diagnostic stage according to planned definitive restoration. In prosthetically guided implantology where ideal placement of implant is determined by the definitive restoration, use of radiographic and surgical stent in conjunction with dental CT scan can play an important role. A stent is an appliance used for radiographic evaluation during treatment planning for implant placement and during surgical procedures to locate optimal implant placement site. The stent with dental CT scan enables the dental team to identify specific sites of prospective implant surgery and hence determines the optimal position and angulation of implant relative to occlusal load. Aided by stent the surgeon can avoid undesirable implant site preparation and minimize unnecessary osteotomy, resulting in favorable design of prosthesis, reduced surgical trauma, reduced surgical time and increased patient comfort. This case report is an insight into the method of fabrication of simple and cost effective stent for implant placement and its advantages over the other techniques of stent fabrication.

Restoration-guided implant rehabilitation of the complex partial edentulism: a clinical report

Background

The hard and soft tissue deficiency is a limiting factor for the prosthetic restoration and any surgical attempt to correct the anatomic foundation needs to be precisely executed for optimal results. The purpose of this paper is to describe the clinical steps that are needed to confirm the treatment plan and allow its proper execution.

Methods

Team work and basic principles are emphasized in a step-by-step description of clinical methods and techniques. This clinical report describes the interdisciplinary approach in the rehabilitation of a partially edentulous patient. The importance of the transitional restoration which sets the guidelines for the proper execution of the treatment plan is especially emphasized along with all the steps that have to be followed.

Results

The clinical report describes the diagnostic arrangement of teeth, the ridge augmentation based on the diagnostic evaluation of the removable prosthesis, the implant placement with a surgical guide in the form of the removable partial denture duplicate and finally the special 2-piece design of the final fixed prosthesis.

Conclusions

Clinical approach and prosthesis design described above offers a predictable way to restore partial edentulism with a fixed yet retrievable prosthesis, restoring soft tissue and teeth and avoiding an implant supported overdenture.

Zirconia abutments for single-tooth implants--rationale and clinical guidelines

Clinical success of an endosseous implant to replace a single tooth is not only defined by its survival. Esthetic parameters have become integral aspects in defining success and failure. All-ceramic abutments have started to play a major role in achieving an esthetically successful result. The material itself, however, is not the exclusive determinant for esthetic success. It is the appropriate design and proper handling of the material and the abutment that enables the clinician to achieve esthetic outcomes that were not possible with traditional metal alloys. This article explores the rationale for using zirconia for prosthetic implant components, explains specific material properties, and discusses strategies and guidelines for the design and successful clinical implementation of CAD/CAM-fabricated zirconia implant abutments.

Anatomically guided implant site preparation technique at molar sites

Immediate postextraction implant placement in the areas of multiradicular teeth is a difficult procedure in view of having to place the implant in an ideal position without jeopardizing its initial stability. The surgeon often faces the problem of directing the initial osteotomy in the medial portion of the alveolus with the difficulty of engaging the inter-radicular septum of the extraction socket. The drill may slip continually leading to an inaccurate site preparation, and consequently to a deficient implant insertion. The fixture is often placed directly into either one of the extraction sockets of the tooth to be replaced. The anatomically guided site preparation technique is a very useful tool to perform implant placement in the areas of multiradicular teeth. This approach of implant insertion consists of a progressive preparation of the implant site using the anatomy and geometry of the root of the multiradicular teeth to be extracted as a reference and as an aid to engage the inter-radicular septum. This places the implants in a favorable and proper position from a biomechanical and occlusal standpoint. The objective of this article is to describe the anatomically guided implant site preparation technique as an aid to favorably place dental implants in multiradicular teeth postextraction.

Provisional restoration options in implant dentistry

Unlike their use in conventional crown and bridge, provisional restorations during implant therapy have been underutilized. Provisional restorations should be used to evaluate aesthetic, phonetic and occlusal function prior to delivery of the final implant restorations, while preserving and/or enhancing the condition of the peri-implant and gingival tissues. Provisional restorations are useful as a communication tool between members of the treatment team which, in most cases, consists of the restorative clinician, implant surgeons, laboratory technicians, and the patient. This article describes and discusses the various options for provisionalization in implant dentistry. Clinicians should be aware of the different types of provisional restorations and the indications for their use when planning implant retained restorations.

Esthetic outcomes of immediate implant placements

BACKGROUND

Single-rooted teeth deemed not restorable via conventional means may be candidates for implant placement at the time of tooth extraction. Immediate implant placements are believed to preserve soft and hard tissue form and contours, reduce the need for augmentation procedures, minimize surgical exposure of the patient, reduce treatment time and improve esthetic outcomes.

METHOD

This retrospective review analyzed the esthetic outcomes of 42 non-adjacent single-unit implant restorations completed using an immediate implant surgical placement protocol.

RESULTS

The mean time in function was 18.9 months (range 6-50 months) and the majority of implants placed had a restorative platform diameter of 4.1 and 4.8 mm. A highly significant change in crown height due to marginal tissue recession of 0.9 +/- 0.78 mm (P=0.000) was recorded for all sites, with no difference seen between implant systems (P=0.837). Thin tissue biotype showed slightly greater recession than thick tissue biotype (1 +/- 0.9 vs. 0.7 +/- 0.57 mm, respectively); however, this difference was not statistically significant (P=0.187). Implants with a buccal shoulder position showed three times more recession than implants with a lingual shoulder position (1.8 +/- 0.83 vs. 0.6 +/- 0.55 mm, respectively) with the difference being highly statistically significant (P=0.000).

CONCLUSIONS

Immediate implant placement requires very careful case selection and high surgical skill levels if esthetic outcomes are to be achieved. Long-term prospective studies on tissue stability and esthetic outcomes are needed.

Failures in implant dentistry

This article describes the many failures and complications that can occur when using implants to support restorations. Most of these failures can be prevented with proper patient selection and treatment planning. Implant failures can be largely classified into four main categories: 1) loss of integration, 2) positional failures 3) soft tissue defects, and 4) biomechanical failures. Each of these will be discussed with examples to illustrate the problem.

Provisional Restorations for Optimizing Esthetics in Anterior Maxillary Implants: A Case Report

The use of implants for the restoration of anterior missing teeth has been established and documented during the past years. However, the use of dental implants in the anterior region is a technique-sensitive procedure. The placement of implants in an ideal position is often not possible because of the lack of sufficient bone. The clinical situation can be further complicated if the teeth were lost as a result of trauma and there is possible damage to the surrounding soft and hard tissues. The restoration of lost anterior teeth and maintenance of the surrounding soft tissues with adequate surgical and prosthetic techniques are a real challenge for the clinician. The aim of this article was to report the laboratory and clinical stages in the restoration of anterior maxillary teeth, which were lost as a result of trauma with implant-supported fixed partial denture. In this case, an intraoperative transfer of the impression posts allowed the construction of provisional restorations, which were inserted at implant uncoverage surgery and contributed significantly to the creation of a better emergence profile and to the final esthetic result.

CLINICAL SIGNIFICANCE

Provisional restorations are an important stage in anterior maxillary implants, allowing guided soft tissue management and creating an esthetic emergence profile.

Screw versus cemented implant supported restorations

Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws. Screw retained implant restorations are the authors' preferred method of securing restorations to implants. This article will be written from this perspective and the advantages and disadvantages of each method of retention will be discussed under the following headings: Aesthetics, Retrievability, Retention, Implant placement, Passivity, Provisionals, Occlusion, Immediate loading, Impression procedures, Long term treatment planning.

Implants in the esthetic zone

To achieve a successful esthetic result and good patient satisfaction,implant placement in the esthetic zone demands a thorough under-standing of anatomic, biologic, surgical, and prosthetic principles. The ability to achieve harmonious, indistinguishable prosthesis from adjacent natural teeth in the esthetic zone is sometimes challenging. Placement of dental implants in the esthetic zone is a technique-sensitive procedure with little room for error. Guidelines are presented for ideal implant positioning and for a variety of therapeutic modalities that can be implemented for addressing different clinical situations involving replacement of missing teeth in the esthetic zone.

Managing congenitally missing lateral incisors. Part III: single-tooth implants

Three treatment options exist for the replacement of congenitally missing lateral incisors. They include canine substitution, a tooth-supported restoration, and a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, anterior relationship, specific space requirements, and condition of the adjacent teeth. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements. Today, the single-tooth implant has become one of the most common treatment alternatives for the replacement of missing teeth. This article closely examines the many interdisciplinary issues that arise when treatment planning the placement of single-tooth implants in patients with congenitally missing lateral incisors. The specific criteria that must be evaluated illustrate the importance of an interdisciplinary treatment approach to achieve optimal esthetics and long-term predictability. This is the final article of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.

CLINICAL SIGNIFICANCE

When treatment planning single-tooth implants to replace congenitally missing lateral incisors, an interdisciplinary approach is necessary to provide the most predictable treatment outcome.

Prosthodontic Considerations for Predictable Single-Implant Esthetics in the Anterior Maxilla

Long-term functional and esthetic success with implant-supported single-tooth restorations requires a comprehensive and interdisciplinary treatment approach. Important parameters include the initial clinical situation, the surgical approach, the provisional phase, and the choice of abutment material and design as well as the definitive restoration. This article presents the main aspects of current treatment protocols and discusses material options and clinical techniques to achieve predictable outcomes.