Association of the Osseodensification Technique with Soft Tissue Substitute in a Limitrophe Edentulous Area: A Clinical Case Report with 5-Year Follow-Up.

The osseodensification (OD) technique differs from conventional milling for dental implant installation in that it preserves the prepared bone and compacts it toward the apex and lateral walls of the socket, resulting in bone compaction. By enabling autografting, bone expansion, and high implant insertion torques, OD has become an increasingly popular option. The aim of this clinical case report is to demonstrate the predictability of combining OD with guided bone and tissue regeneration (GBR/GTR) techniques for bone expansion in the maxilla with reduced thickness, while avoiding other reconstructive surgeries. The report presents the treatment of a 32-year-old female patient who had cosmetic concerns regarding the anterior maxillary region. The patient was using an adhesive prosthesis with pontic on tooth 13 fixed between teeth 12 and 14. After the case was planned, it was decided that bone expansion in the region would be performed using the OD technique. The implant installation (AR Torque, 3.5 × 11.5 mm, Conexão®) and guided bone regeneration (GBR) were done with the assistance of L-PRF (Stick Bone, associated with L-PRF membrane). Following the osseointegration period, a provisional resin crown was fabricated, and a collagen matrix membrane (Mucoderm®) was used to increase vestibular soft tissue volume and shape the patient's gingival profile. After a period of 120 days, the final crown was created and observed for a span of 5 years. The results showed stability of the case along with maintaining its esthetic and satisfactory function. The use of the osseodensification technique coupled with a connective tissue graft substitute has been anticipated for a long time. It has proven to be an excellent alternative to autogenous grafts.

Analysis of Digital Workflow in Implantology.

Digital workflow is increasingly accessible in daily dental practice. It has several benefits in implantology, such as the possibility of precise planning, which results in faster and safer surgery and, consequently, reduced prosthetic complications. There are also disadvantages that must be taken into consideration for successful treatment, such as deviations between the planned and placed implant position and intraoral scanning inaccuracies. We report a clinical case in implantology in which digital workflow was used throughout the process, pointing out its facilities and complications in the daily practice of dental surgeons. The patient had grade II mobility and external root resorption of tooth 11. After virtual planning, a surgical guide was fabricated by a CAD/CAM system, with immediate placement of a dental implant using the guided surgery technique. At the end of the osseointegration period, intraoral scanning was performed for fabrication of the final prosthesis also by a CAD/CAM system. After placement, the patient approved the aesthetic and functional results of the implant. We observed advantages such as simplification of clinical steps and safety of the proposed planning, but there were also disadvantages such as the complexity of digital tools, deviations of the placed implant, and inaccuracy in color selection. It was concluded that digital workflow is a reality that can be integrated into daily dental practice, resulting in greater safety, predictability of results, and ease of use in all clinical stages. However, it should be noted that there are still inaccuracies in digital tools and that a steep learning curve is needed in this area, which, if neglected, may lead to unsatisfactory results.

Guided Surgery with 3D Printed Device: A Case Report.

Dental surgeons need in-depth knowledge of the bone tissue status and gingival morphology of atrophic maxillae. The aim of this study is to describe preoperative virtual planning of placement of 5 implants and to compare the plan with the actual surgical results. Three-dimensional (3D) planning of rehabilitation using software programs enables surgical guides to be specially designed for the implant site and manufactured using 3D printing. A patient with 5 teeth missing was selected for this study. The patient's maxillary region was scanned with cone-beam computed tomography (CBCT), and a cast model was produced. After virtual planning using ImplantViewer, 5 implants were placed using a printed surgical guide. Two weeks after the surgical procedure, the patient underwent another CBCT scan of the maxilla. Statistically significant differences were detected between the virtually planned positions and the actual positions of the implants, with a mean deviation of 0.36 mm in the cervical region and 0.7 mm in the apical region. The surgical technique used enables more accurate procedures compared with the conventional technique. Implants can be better positioned, with a high level of predictability, reducing both operating time and patient discomfort.

The importance of prosthetic planning for implant-supported dentures in esthetic zones - A case report.

INTRODUCTION: Implant-supported dentures in esthetic zones pose a great challenge to dental surgeons, since important factors are involved in treatment success, such as positioning of the implants, morphology of soft tissues, dental esthetics, and biomechanics of the prosthetic structure. PRESENTATION OF CASE: This clinical report describes the case of a patient previously subjected to dental surgery for implant placement on tooth #11 and subsequent prosthetic crown placement. The patient reported poor esthetics due to gingival retraction and changes on the surface of the ceramic material. After proper multidisciplinary planning, the prosthesis was remanufactured, with the selection of new components and periodontal surgery using a modified technique for the handling of soft tissues. After nine postoperative months, the patient had a better gingival alignment and reported esthetic and functional satisfaction. DISCUSSION: After assessing the positioning of implants, it is important to select prosthetic components that are suitable to each clinical case, as they will guarantee clinical success for long time periods. In order to obtain a better gingival contour and avoid an extensive surgical procedure, two techniques were used: the pinhole surgical technique, in which the gingiva is repositioned without the use of grafts; and Tarnow's technique, in which a semilunar incision is made in soft tissues. CONCLUSION: The multidisciplinary approach, combining prosthetic and periodontal procedures, proved to be efficient, improving esthetic outcomes.

Cytokine Levels and Human Herpesviruses in Saliva from Clinical Periodontal Healthy Subjects with Peri-Implantitis: A Case-Control Study.

This study evaluated the presence of cytokines (IL-1ß, IL-2, IL-4, IL-6, MCP-1, MIP-1α, MIP-1ß, and TNF-α) and human herpesvirus (HSV1, HSV2, EBV, CMV, VZV, HHV6, HHV7, and HHV8) in saliva samples taken from subjects with and without peri-implantitis. Forty-two periodontally healthy subjects were divided according to peri-implant condition: healthy and peri-implantitis groups. The clinical parameters as probing depth, clinical attachment level, plaque index, gingival bleeding, bleeding on probing, and suppuration were evaluated. For cytokine detection, multiplex analysis was performed, and PCR assay was used to identify herpesviruses. No significant differences were found in cytokine levels between groups (p > 0.05). The presence of herpesvirus was 1.97-fold higher in patients with peri-implantitis (odds ratio, CI 0.52-7.49). The association of the presence or absence of herpesvirus with the salivary markers was statistically significant for MIP-1ß (p = 0.0087) and TNF-α (p = 0.0437) only in the peri-implantitis group. The presence of herpesviruses in patients with peri-implantitis suggests the development of a proinflammatory environment, which is characterized by increased expression of MIP-1ß and TNF-α in saliva.