A complete digital approach for facially generated full arch diagnostic wax up, guided surgery, and implant-supported interim prosthesis by integrating 3D facial scanning, intraoral scan and CBCT.

Continuous innovation in digital dental technology offers new prospects for creating a complete virtual environment. The technique described adds a facial approach to the conventional digital workflow by incorporating 3D face scans to cone beam computed tomography and intraoral scans. Using this workflow, clinicians can obtain a complete virtual patient for facially generated diagnostic wax up and plan and implement a predictable implant placement and interim prosthesis. This technique provides a full digital workflow for restoratively-driven computer-aided implant planning, guided surgery, and 3D printing of an interim complete-arch fixed implant-supported prosthesis.

The Novel Periosteal Flap Stretch Technique: A Predictable Method to Achieve and maintain Primary Closure in Augmentative Procedures.

BACKGROUND: Correct soft tissue management and achieving tension-free primary closure are pre-requisites for the success of bone augmentation procedures. Several techniques have been developed to facilitate a passive soft tissue primary closure. However, the current techniques are highly invasive and require advanced surgical skills. Hence, the present case series report will describe a novel and simple flap management technique. METHODS: The Periosteal Flap Stretch technique was utilized in bone augmentation procedures for four patients who presented with horizontal and vertical alveolar ridge deficiencies in the anterior maxilla, anterior mandible, posterior mandible, and posterior maxilla. This technique is performed using a blunt surgical curette that engages the periosteum of the mucosa below the mucogingival line of the full-thickness flap and stretches the periosteum in a coronal and outward direction, which results in stretching of the flap without the need for vertical or periosteal releasing incisions. RESULTS: Healing was uneventful for four all cases. No membrane exposure, no soft tissue dehiscence, or any other complications were observed during the six-months healing period after the respective bone augmentation procedures of cases. CONCLUSIONS: The Periosteal Flap Stretch technique is a novel and simple technique that facilities achieving passive and predictable primary soft tissue closure.

A comparative study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession.

BACKGROUND: The primary aim of this randomized, controlled, clinical investigation was to evaluate the differences in clinical parameters of root coverage procedures utilizing coronally advanced flaps (CAF) with and without enamel matrix derivative (EMD). Another aim was to evaluate if EMD can influence keratinization of tissues utilizing these procedures. METHODS: Fifty-eight contralateral sites in 17 patients with > or = 2 mm of Miller Class I, II, and III buccal marginal tissue recession were treated. Test sites received CAF plus EMD while control sites were treated with CAF only, with each patient serving as his own control. Patients were followed for 3 and 6 months. All data were analyzed using the method of generalized estimating equations. A P value <0.05 was considered significant (alpha = 0.05). RESULTS: There was a mean increase in keratinized tissue of 0.60 mm for test sites and a mean decrease of 0.05 mm for control sites. Test sites demonstrated significantly better root coverage (P<0.001), 89.7% and 92.9% root coverage after 3 months and 6 months, respectively, while control sites had 56.6% and 66.8% root coverage after 3 months and 6 months, respectively. There was significantly more root coverage among test sites compared to control sites, regardless of arch or Miller classification. CONCLUSIONS: Based on the results of this study, the application of enamel matrix derivative to denuded root surfaces receiving coronally advanced flaps significantly increased the percentage of root coverage compared to CAF without EMD. In addition, EMD application was accompanied by a significant increase in keratinized tissue 6 months after surgery.