Prospective evaluation of immediate and delayed provisional single tooth restorations.

PURPOSE: The purpose of this study was 2-fold: to determine whether there is a significant difference in the hard and soft tissue response comparing immediate with delayed implant placement after tooth removal, with immediate provisionalization, in maxillary anterior sites; and to determine and compare the crestal bone levels as the primary endpoint variable for implants placed and immediately temporized in extraction sites, to implants placed into extraction sites after the extraction site has been grafted and healed for 4 months, all immediately restored with an anatomic provisional restoration. This aim was to be evaluated by measuring crestal bone levels on standardized digital radiographs of the implants, using implant threads as a monitor of magnification and a pre-extraction reference. Secondary endpoint variables include soft tissue measures compared with method. MATERIALS AND METHODS: A total of 76 patients were recruited and randomized into treatment groups. Group 1 had a maxillary tooth (premolar, canine, lateral or central incisor) removed, with immediate socket grafting, followed by implant placement and provisionalization 4 months later with a single tooth. Group 2 had immediate implant placement and provisionalization. Standardized radiograph holders were used to expose digital radiographs every 6 months from baseline to up to 2 years restored. Soft tissue measures were made from standardized reference points. Data collected were analyzed by a statistician to test the hypotheses. RESULTS: A total of 55 patients completed their follow-up. Twenty-one patients were lost to follow-up because of implant loss (n = 5), 1 treated out of protocol because of labial bone loss found at the time of tooth removal (n = 1), geographic relocation (n = 11), dropped for noncompliance (n = 3), or medical problems (n = 1). The analyses showed no significant differences between groups in implant integration or crestal interdental bone movement on either the implant or the adjacent tooth. The bone level on the implants did move from the baseline levels during the first 6 months but not thereafter. There were no differences (P > .05) observed when comparing the interactions between groups, tooth locations, or time. There was a significant (P < .05) difference in the position of the facial gingival margin with a more apical position of the facial gingival margin in the delayed group compared with the immediate group during the course of the study. CONCLUSIONS: Crestal bone response to immediate or delayed placement of an implant into an extraction site in the maxillary anterior region with immediate provisionalization is similar regarding hard tissue changes. Support of the gingival margin with a provisional at the time of tooth extraction and implant placement preserved 1 mm more facial gingival margin position compared with the delayed group. The decision to use either method must consider the movement of the facial gingival margin, which, in a critical esthetic patient may require soft tissue support from a provisional restoration or similar type of anatomical healing abutment.

Replacement of a fixed partial denture secondary to abutment fracture.

BACKGROUND: The authors present a case that demonstrates the efficient replacement of a fixed prosthesis after a patient's abutment tooth fractured and required extraction. The fractured tooth had a local infection, and the maxillary bone was low-density and limited in height. CASE DESCRIPTION: The authors removed the tooth and grafted the site with particulate bone, while concurrently placing two implants in the edentulous region. After four months, they placed one additional implant and secured a fixed provisional prosthesis within one week. CLINICAL IMPLICATIONS: The patient wanted to minimize the time that she would have to be without a fixed prosthesis. The authors met her expectations by using an accelerated treatment plan.

Treatment planning for multiunit restorations--the use of diagnostic planning to predict implant and esthetic results in patients with congenitally missing teeth.

Patients afflicted with congenitally missing teeth are a unique patient population for consideration of treatment with osseointegrated implants. Frequently, these patients have limited development of the alveolar process and differences in spatial position relative to the opposing arch, which places emphasis on ancillary treatment with orthodontics and oral surgery. A thorough diagnostic workup should include an interdisciplinary approach to ensure optimal treatment and timing of treatment in those who are developing. This article outlines considerations for treating these types of patients and scenarios of treatment paths frequently taken to restore the partially dentate and edentulous to esthetics and function.

Techniques to facilitate provisionalization of implant restorations.

PURPOSE: The aim of this article was to review current methods for immediate provisionalization of single unit implant restorations. METHODS: Four methods are discussed and illustrated in detail, including: preoperative preparation of an abutment and provisional crown using diagnostic models; abutment placement and modification at the time of implant placement; the use of 1-piece or non-prepable abutments; and methods of indexing. Material characteristics for indexing are presented to provide the clinician with an understanding of material handling in relation to accuracy of indexing. CONCLUSION: Depending on clinician and patient case specific criteria, immediate provisionalization of implant restorations can be performed in an efficient manner.

Using ParaPost Tenax fiberglass and ParaCore build-up material to restore severely damaged teeth.

This article describes a technique using ParaPost Tenax Fiber White, ParaPost Cement, and ParaPost ParaCore build-up material to restore a tooth with a significant loss of tooth structure. After successful root canal therapy, the posts were bonded in the canals and the core was built using ParaPost ParaCore build-up material. At that point, the tooth was prepared to receive a conventional porcelain-fused-to-metal crown.

Immediate loading of dental implants in the edentulous mandible.

BACKGROUND: The authors review the literature regarding immediate implant loading in the anterior edentulous mandible, demonstrate the technique they currently use, review preliminary results and present an illustrative case. MATERIALS AND METHODS: The authors conducted a literature search using PUBMED and Ovid databases. They considered for review 31 articles in English from 1969 to 2003 that pertained to immediate loading of the anterior mandible. The authors developed a technique to provide a bar-supported prosthesis on the day of surgery. They treated five patients and followed them up for at least six months. The preliminary results are presented. RESULTS: This literature review demonstrated that immediate loading of anterior mandibular implants is an acceptable method, with predictable results. This case series demonstrates the potential for delivering a final bar on the day of surgery, based on the current evidence and clinical application. CONCLUSIONS AND PRACTICE IMPLICATIONS: The method described provides patients with immediate prosthetic restorations and a decreased treatment time compared with that for the traditional two-stage implant approach.

Single tooth immediate provisional restoration of dental implants: technique and early results.

PURPOSE: Patients desire efficient restoration of missing teeth. Immediate provisionalization of implants at the time of placement can provide the patient with a tooth-like restoration. Our hypothesis is that preoperative fabrication of the implant abutment and provisional restoration can provide successful immediate provisionalization of implants, if specific diagnostic criteria are used for patient selection. PATIENTS AND METHODS: This hypothesis is evaluated by prospectively following 74 implants thus treated for 6 months to 2 years. A technique is presented to illustrate a simple and reliable method to provisionally restore a single tooth restoration. The method involves preoperative placement of an implant analog into a model, preparation of the abutment on the model, and fabrication of a provisional crown out of occlusion. At the time of surgery, the implant is placed according to the prescription of the restorative dentist, the surgeon places the abutment and provisional crown, and the final restoration is fabricated after the implant integrates. RESULTS: Seventy of 74 (94.6%) restorations have been successful with up to 2-year follow-up, which is similar to single tooth implants treated using a 2-stage protocol. CONCLUSIONS: Single tooth immediate provisionalization implants are effective techniques when specific diagnostic criteria are used.

Immediate loading of the edentulous mandible: delivery of the final restoration or a provisional restoration--which method to use?

PURPOSE: Edentulous patients desire restoration of their chewing ability as soon as possible after placement of dental implants. The purpose of this article is to provide clinicians with evidence that immediate loading of implants placed into the anterior mandible can predictably provide the patient with early functional rehabilitation. Two methods are presented that illustrate delivery of the final restoration or a provisional implant-borne prosthesis immediately after implant placement. MATERIALS AND METHODS: A literature search was performed which produced 14 articles in the English literature that provided sufficient evidence that immediate loading is now not experimental and can be recommended as an acceptable treatment alternative. RESULTS: Two practical methods to achieve immediate function are presented in a step-wise manner to illustrate how to deliver this service to the patient. CONCLUSION: Based on our literature review, immediate loading of the edentulous mandible with an implant-borne restoration is an acceptable and predictable method to deliver efficient return of function for the edentulous patient.

Immediate implant placement and provisionalization using implants with an internal connection.

Single-tooth implant restoration has evolved from traditional two-stage surgical procedures to techniques that allow implant placement and provisionalization immediately following tooth extraction. Restorative success using an immediately provisionalized implant system is based upon adherence to several clinical and biological parameters. This article will discuss the clinical and restorative considerations that must be addressed when immediately loading single-tooth implants. Four cases are presented demonstrating the clinical versatility of an immediate implant system for predictable and aesthetic restoration of the posterior region.

Immediate Dental Implant Placement in Sockets Augmented With HTR Synthetic Bone.

PURPOSE: The purpose of this article is to present the results of using immediate implant placement in combination with HTR synthetic bone socket grafting to achieve a predictable restorative result. MATERIAL AND METHODS: Twenty-three hydroxylapatite-coated cylinder implants (Spline, CenterPulse Dental, Carlsbad, CA) were placed into fresh extraction sockets in 19 patients. In each case, HTR synthetic bone (Bioplant, Inc., South Norwalk, CT) was used to fill any voids remaining in the sockets and to augment the facial aspect of the ridge. The restorative phase was initiated approximately 6 months after implant placement. Conventional impression techniques were used and porcelain-fused-to-metal crowns were selected as the final restorations. RESULTS: The prosthetic outcome was evaluated as generally favorable. Only 4 (17%) of the dental implants required an angled abutment. The gingival contour was excellent in 61% and good in 35% of the cases. The emergence profile was evaluated as class I (full papilla) in 37% and class II, III, and IV in 21% each. CONCLUSIONS: The clinical results of this study demonstrate that immediate implant placement in combination with HTR synthetic bone grafting of residual socket voids and crestal deformities is a predictable procedure and provides a good base for successful prosthetic reconstruction. Adequate gingival contour and favorable emergence profile can be expected when combining immediate implant placement and HTR grafting material.

Shear bond strength of four core materials to dentin bonded with light-cured or dual-cured adhesive.

PURPOSE: To measure and compare the shear bond strength of four core materials to dentin bonded with one adhesive (Prime and Bond NT) that was either light-cured or dual-cured. METHODS: The dentin of 80 freshly extracted molars was exposed using a series of abrasive disks. The teeth were divided into eight equal groups, etched with phosphoric acid for 15 seconds and rinsed. Dentin was dried to a moist surface. On 40 teeth, Prime and Bond NT was applied and light-cured for 30 seconds. On 40 teeth, Prime and Bond NT was mixed with the self-cure additive, which was applied to the dentin, and light-cured for 20 seconds. The core materials were then placed following manufacturers' directions onto the cured adhesive. The core material was light-cured, when it was necessary, for 60 seconds and stored for 24 hours in water at room temperature. The specimens were loaded in shear in the Instron until failure at a 5 mm/minute crosshead speed. Data were compared using two factor ANOVA and Tukey's HSD test (P = .05). RESULTS: Both curing mode and core material showed a significant difference. A significant difference between mean shear bond strength for dual and light cured was observed only in CompCore (P = 0.0002). There was no statistical difference when Prime and Bond NT dual-cured was used with chemical- or dual-cured materials.

The evolution of external and internal implant/abutment connections.

The indications for implant dentistry continue to increase, enabling the restoration of partially and totally edentulous patients with greater success and predictability. Recent goals for implant dentistry include simplifying the involved procedures, reducing the duration of therapy for the patient and clinician, and enabling the use of conventional prosthodontic techniques for implant-supported restorations. This article reviews key developments in implantology and highlights the various design characteristics of internal abutment connection implants, demonstrating their clinical application in a detailed case presentation.

All-ceramic restorative system for esthetic implant-supported crowns: in vitro evaluations and clinical case report.

Patient demands for improved esthetics have prompted the development of all-ceramic restorative systems for dental implants, but material strength and restorative costs have presented clinical challenges. Therefore, a new restorative system with tooth-shaped ceramic copings for the anterior and premolar jaw regions has been introduced to address these problems. Fatigue and 17o. compression tests were conducted in vitro to assess the mechanical strength of the 6 tooth-shaped copings and several luting agents of the system. A case report on the clinical use of the components is presented. All 6 tooth-shaped copings significantly exceeded the range of forces associated with restoration in the anterior jaw. Crown-endurance limits for fatigue and 17o. compression were 70% higher and 46% higher, respectively, than the established minimum-fatigue-endurance limits in those categories. In clinical evaluation, the ceramic restorative system performed well and produced excellent results; it has potential for implant restorations in the anterior and premolar regions of the jaw.

Evaluation of hard tissue replacement composite graft material as a ridge preservation/augmentation material in conjunction with immediate hydroxyapatite-coated dental implants.

BACKGROUND: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique. METHODS: Twenty-three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite-coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering. RESULTS: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading. CONCLUSION: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width.

Use of HTR synthetic bone as an augmentation material in conjunction with immediate implant placement: a case report.

Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bioplant HTR synthetic bone (HTR) was used as a ridge preservation/augmentation material in conjunction with this method of DI placement. A 61-year-old white woman requiring extraction of tooth 12 opted for immediate DI placement. HTR was used to fill the remaining socket void and enhance the facial ridge width, and primary closure was attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total site width at DI placement and uncovering. The internal socket width was essentially maintained (6.8 vs 6.6 mm), and the total ridge width showed a change from 8.7 to 9.1 mm. The results of this case suggest that HTR is a useful adjunct in the placement of immediate DIs for the preservation of ridge width.