Extraction of a malpositioned maxillary anterior implant and simultaneous flapless ridge augmentation: a case report.

Periimplantitis in a malpositioned maxillary anterior implant is one of the most challenging situations in implant dentistry. Since the regenerative treatment can often be unpredictable and have esthetic consequences such as soft tissue recession due to flap raising, extraction is sometimes recommended. In order to place a new implant after extraction, a bone regeneration procedure must be carried out. This implies raising a flap and therefore the risk of further interproximal gingival recession. In the case presented in this article, a hopeless implant at position 11 presented severe periimplantitis and soft tissue recession, which also affected the mesial part of tooth 12. Tooth 21 had a root canal treatment and a crown. After the implant extraction, a minimally invasive simultaneous bone regeneration and soft tissue graft procedure was performed to reconstruct the remaining ridge using xenograft, a collagen membrane, and a connective tissue graft (CTG). Ten months later, in order to improve the ridge profile, an augmentation procedure was carried out using a CTG. Three months later, an implant was placed and immediately loaded. Three months after loading, the right lateral incisor that still presented a mesial gingival recession was slowly extruded by orthodontic treatment until the papilla was symmetrical to the contralateral one. At the end of the orthodontic extrusion, an implant-supported crown was placed at position 11 and a tooth-supported crown delivered in place of tooth 21. A composite restoration was performed on tooth 12. One year later, the soft tissue level was almost symmetrical at incisor level and the periimplant bone level at implant 11 was stable.

The three-layer technique for immediate implants on teeth without a buccal bone wall: a case report.

The buccal bone wall is the part of the socket of an anterior tooth that is most susceptible to resorption. Immediate implants offer advantages in terms of time, comfort, and esthetics, especially regarding the maintenance of the papillae architecture. However, the loss of the buccal bone wall is often a limitation for such a therapy. This case report describes a clinical procedure designed to reconstruct the buccal bone wall to restore an anterior tooth where this wall was absent. The approach involved a flapless immediate implant based on the principles of guided bone regeneration (GBR), and consisted of the preparation of a large, flapless recipient bed ad modum envelope, immediate implant placement, deposition of xenograft surrounding the implant surface, and coverage with a collagen membrane. Finally, a palatal connective tissue graft (CTG) was placed, and the natural tooth crown acting as a temporary restoration was delivered. One year later, a zirconia-ceramic crown was delivered. Two years after implant placement, the soft tissue level was stable. No signs of inflammation or bleeding were observed, and periapical radiographic examination revealed bone stability.

The saddle connective tissue graft: a periodontal plastic surgery technique to obtain soft tissue coronal gain on immediate implants. A case report.

Based on recent studies regarding the advantages of flapless immediate implants on the maintenance of the soft tissue architecture (especially at papillae level) in those situations where it is necessary to extract an anterior tooth, this case report describes a clinical procedure designed to replace a hopeless central incisor (2.1) showing root resorption adjacent to an implant-supported crown (1.1), whose gingival margin is 2 mm coronal regarding the hopeless tooth to be replaced. After the extraction of the hopeless tooth (2.1), a flapless immediate implant was placed. The implant-bone gap was then filled with bone substitute and a palatal connective tissue graft was placed ad modum saddle extending at buccal level from apical to the mucogingival line, sealing the socket and extending until 6 mm at palatal level ad modum saddle. This procedure allowed symmetry of the soft tissue margins between the two implants (1.1 and 2.1) to be obtained as well as the preservation of the inter-implant papillae (1.1).

Immediate placement and restoration of implants in the esthetic zone: Trimodal Approach therapeutic options.

Recently, a number of clinical and animal studies have been published suggesting the advantages of using immediate post-extraction implants under a flapless protocol, followed by the simultaneous placement of an implant-supported provisional restoration (Trimodal Approach [TA]). Indications and risk of complications of this therapeutic option have also been thoroughly discussed in the literature. Different protocols have been advocated in order to minimize the possible esthetic impact of the post-extraction remodeling of the bundle bone. These include a correct implant position, a flapless approach, the use of an immediate implant-supported provisional restoration, and filling the osseous gap with different biomaterials or thickening the mucosal compartment through soft-tissue grafts. These techniques have been mostly indicated when intact alveolar walls are present at the time of tooth extraction. In this article, the conventional TA is described. Thereafter, variations of this option are discussed, being the modification of the osseous compartment (TAO), and the modification of the mucosal and osseous compartments (TAOM).

Retrospective multicenter study of 230 6-mm SLA-surfaced implants with 1- to 6-year follow-up.

PURPOSE: Using short implants poses a challenge in implant surgery. Implant surfaces have evolved, making it possible to improve the success of short implants substantially. However, there is still little information about the long-term predictability achieved with short, rough-surfaced implants. The objective of this study was to evaluate the long-term survival rate of 6-mm rough implants. MATERIALS AND METHODS: A retrospective multicenter analysis of the survival of short 6-mm SLA-surfaced implants was conducted. A total of 230 implants placed in 159 patients were included. The follow-up time ranged between 1 and 6 years. RESULTS: Seven of the 230 implants failed, which gives a cumulative survival rate of 96.4%. Two hundred and fourteen implants were placed in the mandible (93.1%), as opposed to 16 placed in the maxilla (6.9%). Five implants failed during the osseointegration period, and two failed after receiving the prosthetic load. No statistically significant differences were found (P < .44). Of the loaded implants, 209 were splinted to other implants, as opposed to 14 that were not. One implant failed in each group, resulting in a 99.5% for the splinted implants and 92.9% for the unsplinted implants. No statistically significant differences were found between the splinted and unsplinted groups (P < .12). CONCLUSIONS: The short implants used in this study displayed high longterm predictability when placed in the mandible and splinted. There is insufficient- information to extrapolate these results to the maxilla and non-splinted implants.

Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype.

PURPOSE: The aim of this prospective study was to evaluate the soft tissue changes around implants in the aesthetic zone, placed under a trimodal approach (immediate post-extraction placement, flapless, and immediate provisional restoration) and its relationship to gingival/periodontal biotype of the patient. MATERIALS AND METHODS: The sample consisted of 14 patients from two private practices that were in need of a tooth extraction in the anterior maxillary region (cuspid to cuspid) and were candidates to a replacement with a dental implant. An initial measurement (baseline) of the position or the mesial and distal papillae and gingival zenith was made at this time, with a rigid dental-supported stent and an electronic precision caliper, able to the second tenth of a millimeter; after careful tooth extraction, the periodontal thickness, at a point 5 mm apical to de gingival buccal margin, with an analogical thickness gauge, able to one tenth of a millimeter. Once the implant was inserted an immediate provisional restoration was delivered. To evaluate the soft tissue changes measurements were repeated at 3, 6, and 12 months. A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to patient's periodontal thickness. RESULTS: All 14 patients received Straumann (®) implants (9 Tissue Level [TL] Regular Neck [RN], 2 TL Narrow Neck [NN], 2 Bone Level [BL] Narrow Crossfit [NC], and 1 BL Regular Crossfit [RC]). All implants integrated and none had any biological complications. Three provisional restorations presented screw loosening and retightened once and one loss retention and was recemented once. In one patient, with a severe bruxing habit, the final restoration suffered screw loosening and was retightened. Of the final restorations, 12 were screw-retained and 2 cemented on custom-made Zirconia abutments. A mean recession of the buccal margin of 0.45 mm was recorded at 12 months ( ± 0.25 mm). An acceptable papilla level was present in all cases at 1 year, with mean changes of 0.38 mm ( ± 0.60) for the mesial and 0.80 mm ( ± 0.90) of the distal papilla, respectively. No correlation could be established between the soft tissue changes and the periodontal biotype of the patient. CONCLUSIONS: Within the limitations of this study, the good aesthetic outcome and minimal complications seem to validate the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone. No correlation between the patient's gingival biotype and the soft tissue alterations could be established. Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes.