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Objective@#To investigate the effect of the socket-shield technique (SST) concurrent with immediate implant placement and provisionalization (IIPP) in the aesthetic restoration of anterior teeth.@*Methods@#A case of maxillary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness, combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding@*Results@#Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time. The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST, which presented a better aesthetic result. The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth, whose dental, periodontal and periapical tissues are healthy and intact. In the esthetic zone, root shielding is effective in maintaining the soft and hard tissue contour on the labial side of the implant. However, there is no consensus on the technical details of SST, such as the ideal coronal height and thickness of the shield, and the management of the gap between the shield and the implant. Thus, more clinical studies and histologic evidence are needed to provide a reference for clinical decision-making. In addition, digital technology can improve the accuracy of implant placement and shield preparation.@*Conclusion@#The correct application of SST combined with IIPP in the esthetic zone can ensure esthetic results. However, more high-quality evidence-based medical evidence is needed for its long-term efficacy, and indications should be strictly controlled during clinical application.
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Objective To investigate the influence of implant location and axial direction on stress distributions at the implant bone interface of maxillary central incisors with different alveolar fossa morphology by immediate implantation under immediate weight-bearing. Methods With reference to dental cone beam computed tomography (CBCT) image data from a healthy adult, the three-dimensional ( 3D) finite element models of maxillary central incisors with three types of alveolar fossa ( buccal, mediate, and palatal type) by immediate implatation under immediate weight-bearing were established. Different implant sites ( apical site, palatal / labial site) and axial directions (long axis of the tooth, long axis of the alveolar bone) were simulated. The established models were subjected to 100 N force at different angles (0°, 30°, 45°, 60°, 90°). The stresses in the alveolar bone around the implant were analyzed by the ANSYS software. Results Twelve 3D finite element models of maxillary central incisors with different alveolar fossa morphology by immediate implantation under immediate weight-bearing were successfully established. When alveolar fossa with buccal and mediate shape was applied with immediate implantation under immediate weight-bearing, it was easier to obtain good biomechanical properties of the implant-bone interface when implants were placed at palatal site along long axis of the alveolar bone. When alveolar fossa with palatal shape was applied with immediate implantation under immediate weight bearing, the equivalent stresses on peri-implant alveolar bone were much smaller than those on apical site, regardless of whether the implant was placed along long axis of the tooth or the long axis of the alveolar bone. Conclusions Different alveolar fossa morphology, implant location and axial direction will affect characteristics of implant-bone interface of maxillary central incisors with immediate implantation under immediateweight-bearing. In clinical practice, surgical planning on different axial direction and location of implantation should be developed for alveolar fossa with different morphology.
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@#With the development of computer-aided surgery and rapid prototyping via 3D printing technology, digital surgery has rapidly advanced in clinical practice, especially in the field of oral and maxillofacial surgery. 3D printing technology has been applied to the functional restoration and reconstruction of the jawbone. Before surgery, a 3D digital model is constructed through software to plan the scope of the osteotomy, shape the bone graft and plan the placement of the implant. Additionally, 3D models of personalized surgical instrument guides are printed prior to surgery. With these 3D-printed models and guides, accurate excision of the jaw tumor, accurate placement of the grafted bone and precise placement of implants can be achieved during surgery. Postoperative evaluation of accuracy and function shows that 3D printing technology can aid in achieving the biomechanical goals of simultaneous implant placement in jaw reconstruction, and in combination with dental implant restoration, the technology can improve patients' postoperative occlusal and masticatory functions. Nevertheless, 3D printing technology still has limitations, such as time-consuming preparation before surgery. In the future, further development of 3D printing technology, optimization of surgical plans, and alternative biological materials are needed. Based on domestic and foreign literature and our research results, we have reviewed the process and clinical application prospects of jaw reconstruction via 3D printing technology to provide a reference for oral and maxillofacial surgeons.
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@#Chronic periodontitis is a prevalent disease; if left untreated, it is a main indication for tooth extraction and can lead to tooth loss. The reactive soft tissue, formed as a result of the immune response to chronic inflammation, is left in the compromised socket. The major concern is how to deal with the residual reactive soft tissue. Conservative thought states that the reactive soft tissue should be completely debrided. In addition, novel practices concerning the reactive soft tissue were proposed in recent trials, which demonstrated that there might be merits for soft and hard tissue regeneration with preservation of the reactive soft tissue. Studies have shown that mesenchymal stem cells exist in inflammatory reactive soft tissue, stressing their potential in tissue regeneration. Although the therapeutic value is highly promising, the specific components of the reactive soft tissue and the standard on whether it should be preserved need further investigation.
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Objective@#To study the postoperative soft and hard tissue changes and aesthetic effect of immediate implantation and provisionalization (IIPP) combined with guided bone regeneration (GBR) for a single anterior maxillary tooth with a thin facial bone phenotype.@*Methods @# A total of 34 patients with thin facial bone (<1 mm) were categorized into two groups: a flapped GBR group and a flapless group. Tooth extraction and IIPP were conducted at the sites in both groups. Implant survival rates, dimensional changes in soft and hard tissues during the six- and twelve-month follow-ups, the pink esthetic score (PES) and patient satisfaction scores at the twelve-month follow-up were measured.@*Results @#The implant survival rates were 100% in both groups, and no complications occurred during the 12 months after surgery. The facial bone thickness remained over 2 mm on all measured sides, and the height of the facial bone crest remained at 1.39 mm at the 12-month follow-up in the flapped GBR group, while the facial bone thickness remained less than 2 mm on all measured sides, and the height of the facial bone crest remained at 1.03 mm at the 12-month follow-up in the flapless group. The absorption of facial bone at all measured sides in the flapped GBR group was greater than that in the flapless group (P<0.05). There was no significant difference between the two groups in the dimensional changes of labial soft tissues during the six- and twelve-month follow-ups (P>0.05). The mean PES scores were 10.29 ± 2.34 for the flap GBR group and 10.12±1.78 for the flapless group (P = 0.807). The mean patient satisfaction scores were 8.65 ± 1.27 in the flapped GBR group and 8.76 ± 1.25 in the flapless group, and the patients in both of the groups were satisfied with the esthetic outcomes (P = 0.787). @*Conclusion @#IIPP combined with GBR might be a prospective treatment strategy for a single anterior maxillary tooth with a thin facial bone phenotype, but the esthetic risks should never be ignored.
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Objective To investigate biomechanical properties of personalized titanium root-analogue implants with porous surface, so as to provide theoretical basis for the design and clinical implantation of such implants. Methods Based on CT data, the personalized model of root-analogue implant with porous surface was designed by using 3-matic software, and after registering it with the mandible model, the mesh was divided and material parameters were attributed. The implant was applied with 200 N loading, and the maximum stress of the implant and the stress and strain of the bone around the implant were analyzed. An appropriate clinical case was selected and the implant was implanted immediately after tooth extraction for conducting clinical evaluation. Results The peak stress of the personalized root-analogue implant with porous surface was mainly concentrated on the interface between the solid structure and the porous structure of the implant. The maximum stresses of the solid structure and porous structure were 137.710 and 37.008 MPa, respectively, which were smaller than its yield strength. The three-dimensional (3D) printed porous root-analogue implants had good initial stability immediately after implantation, with minimal trauma and similar mechanical transmission to natural teeth. This simplified the surgical process, shortened the treatment time, and had high patient satisfaction. Conclusions The 3D printed root-analogue implant with porous surface explores a new method for immediate implantation after tooth extraction.
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BACKGROUND: Some studies have shown that topical application of zoledronic acid and topical application of silver nanoparticles can promote bone formation, but the difference between two methods has not been reported. OBJECTIVE: To investigate the effect of topical application of zoledronic acid versus topical application of silver nanoparticles on rabbit tooth extraction socket immediate implantation of titanium screw bonding. METHODS: Twenty-four New Zealand white rabbits were randomly divided into zoledronic acid and silver nanoparticles groups (n=12/group). After removing four incisors of the upper and lower jaws, the mixture of nanometer silver and nanometer hydroxyapatite and nanometer zoledronic acid hydroxyapatite were respectively filled in the tooth extraction pit of the two groups, and titanium screw was implanted at the same time. The isolated specimens of the upper and lower mandibles were taken at 4, 8 and 12 weeks after surgery. The data reflecting the osseointegration around the implant were obtained through gross observation, torque test, bone density test and histomorphological observation. The study was approved by the Ethical Committee of the Third Hospital of Hebei Medical University in December 2015, approval No. Z2015-021-1. RESULTS AND CONCLUSION: (1) The test results of torque mechanics showed that the average torque peak value of all titanium nails increased with the extension of time (the average value of torque peak value) and reached the maximum value at 12 weeks (the average value of torque peak value). At 4, 8 and 12 weeks after surgery, the torque peak value of titanium screw in the zoledronic acid group was higher than that in the silver nanoparticles group, and the stability of titanium screw in zoledronic acid group was better than that in silver nanoparticles group, but the difference was insignificant (P>0.05). (2) General observation and histological observation showed that at 4, 8 and 12 weeks after surgery, the hardness and structure of bone around the implants in the zoledronic acid group were significantly better than those in the silver nanoparticles group. (3) Bone mineral density analysis results showed that, at 4, 8 and 12 weeks after surgery, the gray value of bone tissue around the titanium screw in the zoledronic acid group was higher than that in the silver nanoparticles group at the same period (P>0.05). (4) These results suggest that the osseointegration of immediate implantation using nanometer zoledronic acid hydroxyapatite is better than that of the mixture of nanometer silver and nanometer hydroxyapatite.
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OBJECTIVE@#To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socket with poor bone quality beneath the sinus.@*METHODS@#We collected the data from the patients undergoing extraction of maxillary molars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extraction were performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of the sinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory function was observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputed tomography (MCT).@*RESULTS@#We analyzed 32 extraction cases with immediate implantation in the maxillary molar sockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameter of the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied from the minimum (in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N·cm. The postoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after the operation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installed on the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after the operation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolar ridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069±0.6253 mm (=1.2904, >0.1), 0.5272± 0.3331 mm (=1.5836, >0.05), 0.5416±0.4048 mm (=1.3379, >0.05), and 0.5172±0.3874 mm (=1.3351, >0.05), respectively; the change of the alveolar ridge width was 0.5522±0.4381 mm (=1.2604, >0.1) mm. The dimension of the alveolar bone underwent no significant changes after the operation in these patients.@*CONCLUSIONS@#Immediate implantation in the maxillary extraction socket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of less trauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as compared with delayed implantation.
Subject(s)
Humans , Middle Aged , Dental Implantation , Methods , Dental Implants, Single-Tooth , Feasibility Studies , Immediate Dental Implant Loading , Methods , Maxilla , Molar , General Surgery , Tooth Extraction , Tooth Socket , Treatment Outcome , X-Ray MicrotomographyABSTRACT
Objective: To investigate the treatment and aesthetic restoration of anterior tooth loosening and falling in the patient with severe periodontitis, and to clarify the curative effect of multidisciplinary treatment in the anterior esthetic zone, and to provide reference for its clinical application. Methods: The male patients was 57 years old, and saw a dcotor becasuse of anterior teeth loosening and discomfort for more than half a year. The specialized examination: 11, 21, 22, 41 III° loose, 42 II° loose. After multidisciplinary consultation, the teeth were treated with periodontal therapy. After inflammation was controlled, 11, 21, 22, 41, 42 were removed for immediate implantation. The platelet rich fibrin (PRF) combined with guided bone regeneration (GBR) was used to repair the bone defect around the implants. Because of the aesthetic requirements of the patients, tooth preparation was performed for 12, 13, 23, 31, 32, 33, 43 after root canal therapy. Fixed restorations were performed in 13-23 and 33-43. Results: After operation, the implant was well positioned and the bone surrounding the implant was adequate. The soft tissue in the mouth healed well and the degree of the alveolar ridge was better. After restoration, the masticatory and phonation function of the teeth were restored, and the patients were satisfied with the aesthetic effect. Conclusion: Through the application of multidisciplinary treatment, the implant repair of the anterior esthetic zone of the patient with severe periodontitis is successfully achieved, which opens a new way for the diagnosis and treatment of the anterior esthetic zone.
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There are different degrees of bone defect in immediate implantation for anterior dentition. During conventional guided bone regeneration, the wound was difficultly closed in operation,and there was more inflammatory response and infection risk. In this paper,a case of immediate implantation for anterior dentition combined with platelet rich-fibrin(PRF) was reported,the clinical effects of guiding bone regeneration and alleviating the inflammatory response.
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[Objectives]To observe the clinical effects of the immediate implant placement of Zimmer dental implant sys-tem in the mandibular posterior region.[Methods]67 cases with a total of 89 mandible posterior teeth to deal with immediate implantion which selected to be treated with Zimmer dental implant system.76 teeth between implant and tooth socket bone wall were simultaneously filled with Bio-oss Collagen.The upper structure was repaired with PFM porcelain crown after the postoperative phase I of 3~6 months.All the patients were followed up for 6~24 months.[Results]During the clinical follow up,the implant survival rate was 100%. In 67 patients,89 implants was successfully loaded,with stable implants,good condition in synosteosis and without adverse subjective symptoms. All of the 67 patients had achieved good synosteosis and success loads clinically and radiologically.[Conclusion]A good osseointegration is obtained in the mandibular posterior re-gion with Zimmer dental implant system,Correctly dealing with Bio-oss Collagen between implant and tooth socket bone wall.At the same time,it can shorten the time of therapy,simplify the procedure,so that the clinical results are more satis-factory.
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Objective:To investigate the treatment and aesthetic restoration of anterior tooth loosening and falling in the patient with severe periodontitis,and to clarify the curative effect of multidisciplinary treatment in the anterior esthetic zone,and to provide reference for its clinical application.Methods:The male patients was 57 years old,and saw a dcotor becasuse of anterior teeth loosening and discomfort for more than half a year.The specialized examination:11,21,22,41 Ⅲ°loose,42 Ⅱ°loose.After multidisciplinary consultation,the teeth were treated with periodontal therapy.After inflammation was controlled,11,21,22,41,42 were removed for immediate implantation.The platelet rich fibrin(PRF)combined with guided bone regeneration(GBR)was used to repair the bone defect around the implants.Because of the aesthetic requirements of the patients,tooth preparation was performed for 12,13,23,31,32,33,43 after root canal therapy.Fixed restorations were performed in 13-23 and 33-43.Results:After operation,the implant was well positioned and the bone surrounding the implant was adequate.The soft tissue in the mouth healed well and the degree of the alveolar ridge was better.After restoration, the masticatory and phonation function of the teeth were restored,and the patients were satisfied with the aesthetic effect.Conclusion:Through the application of multidisciplinary treatment,the implant repair of the anterior esthetic zone of the patient with severe periodontitis is successfully achieved,which opens a new way for the diagnosis and treatment of the anterior esthetic zone.
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A implantação imediata após a exodontia com a confecção de um elemento protético provisório tem se tornado uma proposta viável, amplamente documentada na literatura e que diminui consideravelmente o tempo de tratamento e a quantidade de intervenções, contribuindo para maior satisfação do paciente. A observação de fatores relevantes da estrutura óssea remanescente e do contorno gengival da região deve ser considerada, com o objetivo de otimizar o prognóstico. Outras considerações quanto ao desenho e superfície do implante, conduta cirúrgica e protética também devem ser criteriosamente analisadas. O objetivo deste trabalho foi demonstrar, por meio de um relato de caso clínico, a utilização de implante imediato após a exodontia de um dente perfurado endodonticamente, seguido de provisionalização imediata, utilizando-se da coroa do dente extraído como elemento provisório, com acompanhamento de seis meses.
Immediate implantation after extraction followed by a provisional prosthetic element has become a viable proposition, widely documented in the literature and which significantly reduces treatment time and number of interventions, contributing to greater patient satisfaction. The observation of relevant factors of the remaining bone structure and gingival contour of the region must be considered in order to optimize the prognosis. Other considerations such as implant design and surface, surgical and prosthetic protocols should also be carefully analyzed. The objective of this paper is to demonstrate through a clinical case report, the use of immediate implant after extraction of a tooth endodontically perforated, followed by immediate provisionalization, using the crown of the extracted tooth as provisional element representing the 6-month follow-up report.
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Humans , Female , Adult , Dental Implants , Esthetics, DentalABSTRACT
Objective:To study the osseointegration of implant in fresh extraction socket with or without bone grafting.Methods:In the mandibular premolar region of 6 beagle dogs,bone defect in the size of (3~4)mm ×(3~4)mm ×(5 ~6)mm on the mesial wall of the mesial root socket was made.On control side implants were installed immediately into the extraction sockets(group A).On an-other side Bio-Oss grafts and membrane(GBR)were placed following implantation(group B).All animals were sacrificed 3 months af-ter implantation,specimens were examined for histo-morphometric analysis of bone to implant contact and new bone formation.Results:No implant was loosening in the 2 groups.New bone was filled in the bone defect areas in 2 groups.No statistical difference of the per-centage of new bone formation and bone-to-implant contact ration(BIC)was observed between 2 groups.Conclusion:With the defect in a certain size on the root socket wall osseointegration may occur between the new bone and implant without bone transplantation.
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PURPOSE: The purpose of this study was to provide an actual guideline in determining the shape, diameter, and position of the implant in immediate implantation by the measurement of the thickness of facial and palatal plate, the thickness of cortical bone on the facial and palatal plate, the diameter of the root, and the distance between the roots in the cadavers. MATERIALS AND METHODS: The horizontal sections of 20 maxillae were measured and analyzed to obtain the average values. Resin blocks were produced and cut serially at 1 mm intervals from the cervical line to the root apex. Images of each section were obtained and the following measurements were performed: The thickness of the facial and palatal residual bone at each root surface, the thickness of the facial and palatal cortical bone at the interdental region, the diameter of all roots of each section on the faciopalatal and mesiodistal diameter, and the interroot distance. Three specimens with measurements close to the average values were chosen and 3-dimensional images were reconstructed. RESULTS: The thickness of the facial and palatal cortical bone at the interdental region in the maxilla, the buccal cortical bone was thicker in the posterior region compared to the anterior region. The interroot distance of the alveolar bone thickness between the roots increased from anterior to posterior region and from coronal to apical in the maxilla. CONCLUSION: In this study, the limited results of the morphometric analysis of the alveolar ridge using the sections of maxilla in the cadavers may offer the useful information when planning and selecting optimal implant for immediate implantation in the maxilla.
Subject(s)
Alveolar Process , Cadaver , MaxillaABSTRACT
Esthetics is important in restoring maxillary anterior area. Alveolar bone resorption and loss of interdental papilla may be minimized by immediate implantation. Previous studies showed successful results with the immediate implantation in healthy extraction socket, while many of these studies objected the immediate implantation into extraction sites with periapical lesions. Recent studies, however, reported successful results of the immediate implantation into extraction sites with periapical lesions with careful debridement of extraction sockets and general medication of antibiotics prior to implantation. A 73-year-old female visited the department of Prosthodontics in oo University Dental Hospital with the chief complaint of fallen post-core and crown on left maxillary incisor. Although the incisor was with vertical root fracture and periapical lesion, the immediate implantation following the extraction of tooth was planned. Thorough socket debridement, irrigation with chlorhexidine, and tetracycline soaking were followed by immediate implantation. The general medication of antibiotics (Moxicle Tab.(R), 375 mg) was prescribed before and after the surgery. Immediate provisional restoration was delivered two days after the surgery, and the definitive metal-ceramic restoration was placed about six months later after reproducing the emergence profile from the provisional restoration. This case presents satisfying result esthetically and functionally upto two years after the placement of prosthesis with the harmonious gingival line and no loss of marginal bone.
Subject(s)
Aged , Female , Humans , Anti-Bacterial Agents , Bone Resorption , Chlorhexidine , Crowns , Debridement , Esthetics , Gingiva , Incisor , Prostheses and Implants , Prosthodontics , Tetracycline , ToothABSTRACT
PURPOSE: The present study was performed to evaluate the effect of surface treatment of the cervical area of implant on bone regeneration in fresh extraction socket following implant installation. MATERIALS AND METHODS: The four minipigs, 18 months old and 30 kg weighted, were used. Four premolars of the left side of both the mandible and maxilla were extracted. phi3.3 mm and 11.5 mm long US II plus implants (Osstem Implant co., Korea) with resorbable blasting media (RBM) treated surface and US II implants (Osstem Implant co., Korea) with machined surface at the top and RBM surface at lower portion were installed in the socket. Stability of the implant was measured with Osstell(TM) (Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden). After 2 months of healing, the procedures and measurement of implant stability were repeated in the right side by same method of left side. At four months after first experiment, the animals were sacrificed after measurement of stability of all implants, and biopsies were obtained. RESULTS: Well healed soft tissue and no mobility of the implants were observed in both groups. Histologically satisfactory osseointegration of implants was observed with RBM surface, and no foreign body reaction as well as inflammatory infiltration around implant were found. Furthermore, substantial bone formation and high degree of osseointegration were exhibited at the marginal defects around the cervical area of US II plus implants. However, healing of US II implants was characterized by the incomplete bone substitution and the presence of the connective tissue zone between the implant and newly formed bone. The distance between the implant platform (P) and the most coronal level of bone-to-implant contact (B) after 2 months of healing was 2.66 +/- 0.11 mm at US II implants group and 1.80 +/- 0.13 mm at US II plus implant group. The P-B distance after 4 months of healing was 2.29 +/- 0.13 mm at US II implants group and 1.25 +/- 0.10 mm at US II plus implants group. The difference between both groups regarding the length of P-B distance was statistically significant(p<0.05). Concerning the resonance frequency analysis (RFA) value, the stability of US II plus implants group showed relatively higher RFA value than US II implants group. CONCLUSION: The current results suggest that implants with rough surface at the cervical area have an advantage in process of bone regeneration on defect around implant placed in a fresh extraction socket.