A Prospective Clinical Assessment of BioHorizons Tissue-Level Implants.

This investigation was designed to evaluate crestal bone stability and soft tissue maintenance to Laser-Lok tapered tissue-level implants. Twelve patients presenting with an edentulous site adequate for the placement of two implants were recruited from four dental offices (2 to 4 patients per office). Each patient received two Laser-Lok tissue-level implants placed with a 3-mm interimplant distance according to a surgical stent. The implants were placed so that the Laser-Lok zone sat at the junction between hard and soft tissues. A total of 24 implants were placed, and all achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after receiving the final prosthetic restoration.

Biologic restoration: the effects of composite inlays on patient treatment plans.

A technique for restoration of decayed and fractured teeth with composite inlays or onlays is presented. This approach conserves the tooth structure, requires less preprosthetic periodontal surgical intervention, and provides excellent functional results, while minimizing the incidence of post-therapeutic endodontic involvement. Two thousand seven teeth were restored using this technique over a period of 120 months, with a mean time of 59.6 months in function. The technique is described, and the advantages of this treatment modality are discussed.

Root coverage esthetic score after treatment of gingival recession: an interrater agreement multicenter study.

BACKGROUND: The root coverage esthetic score (RES) system was proposed for evaluating esthetic outcomes of root coverage procedures. The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists. METHODS: Eleven periodontists were selected in different clinical centers. Each operator had ≥15 years of experience in mucogingival surgery. Each periodontist was trained to use RES before the beginning of the study. Subsequently, baseline and post-treatment (6 months) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method. A two-way random interclass correlation coefficient and 95% confidence interval (CI) were used to assess the global interrater agreement for RESs. RESULTS: The total interrater agreement for RESs was 0.92 (95% CI: 0.88 to 0.95), which indicated that an almost perfect agreement was achieved. CONCLUSION: Tested individually by a group of periodontists, the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures.

The tunnel technique: a different approach to block grafting procedures.

The purpose of this study was to report on the tunnel technique, an approach to alveolar ridge augmentation in partially edentulous patients that uses bone blocks immobilized with titanium screws prior to implant placement. Twenty patients (7 men and 13 women) between the ages of 35 and 65 years were treated during a 2-year period with the tunnel technique. The technique consists of creating the tunnel, exposing the crestal defect, harvesting the graft, and final adaptation and stabilization of the graft in the defect site. Nineteen of the 20 patients treated had an adequate level of bone postoperatively to place implants 3.75 or 4 mm in diameter and at least 10 mm in length. None of the patients reported temporary or permanent lower lip paresthesia. There were also no infections reported in the donor sites. This method eliminates the need for a membrane because the integrity of the periosteum is preserved, and it greatly reduces patient discomfort since only one surgical field is needed. The learning curve for this procedure is relatively short.

Sinus grafting using autogenous bone and platelet-rich plasma: histologic outcomes in humans.

Four partially edentulous patients received particulate autogenous bone and platelet-rich plasma (PRP) in one sinus and particulate autogenous bone alone in the contralateral sinus. After 6 months of healing, two or three Osseotite implants were inserted, and an additional Osseotite mini-implant was placed into the graft through the lateral wall of the sinus. At abutment connection, the mini-implants were retrieved for histologic examination. Despite similar clinical and radiographic healing patterns, a higher bone-to-implant contact rate was observed on the implants placed in bone and PRP than on those placed in bone only (46.75% +/- 13.6% versus 20.5% +/- 5.57%, respectively).

Interdisciplinary treatment planning for single-tooth restorations in the esthetic zone.

UNLABELLED: This article presents a conservative approach for restoring single anterior teeth in patients with congenitally missing maxillary lateral incisors, emphasizing the importance of interdisciplinary treatment planning. Minor orthodontic treatment was necessary to create the space for implant placement. Once the fixtures were inserted and the temporary abutments connected to the implants, the provisionals were relined with the use of a repositioning stone key. From the diagnostic wax-up, it was decided that in order to attain a satisfying final esthetic outcome, it was necessary to also restore the distal aspect of the central incisors and the right first premolar for anatomical and functional reasons. Finally, after having screwed the abutments on the implants, inducing a torque of 20 Ncm, the metal-ceramic restorations were cemented with temporary cement. CLINICAL SIGNIFICANCE: This article presents a systematic approach for restoring anterior teeth in the esthetic zone using a diagnostic additive wax-up and an interdisciplinary approach to optimize the final esthetic outcome.

Collagen fiber orientation near a fractured dental implant after a 5-year loading period: case report.

PURPOSE: Fracture of an implant is one of the possible complications of dental implants. It is a quite rare event but of high clinical relevance. Nevertheless, it represents an important opportunity for evaluating the peri-implant bone-tissue response to implant overloading in human beings. The aim of the present study was a scanning electron microscopy evaluation of a screw-shaped implant retrieved because of fracture and a birefringence analysis of the tissue near the fractured implant. MATERIALS AND METHODS: There was 1 fractured screw-shaped implant retrieved from a patient with a trephine bur, and it was processed for histology. The specimen was analyzed under both scanning electron microscopy and circularly polarized light microscopy. RESULTS: The scanning electron microscopy fractography analysis showed the typical signs of a fatigue-fracture, with large plastic deformations on the implant. The fracture seemed to start from the internal coil of the implant. Under circularly polarized light microscopy investigation, a bone-implant contact percentage of 81.6% +/- 1.5% (mean +/- standard deviation) was found. The amount of the transverse collagen fibers was of 68.3%, and the amount of the longitudinal collagen fibers was of 31.7%. The difference was statistically significant for z = 2.247 (P = 0.025). CONCLUSION: The fracture of the implant was most probably correlated to a fatigue of the material mainly associated to a lesion of the internal coil. The high level of bone-implant contact percentage was correlated to a predominant transverse collagen fiber orientation of the collagen fibers in the peri-implant bone.

A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots.

The objective of this investigation was to determine the fate of thin buccal bone encasing the prominent roots of maxillary anterior teeth following extraction. Resorption of the buccal plate compromises the morphology of the localized edentulous ridge and makes it challenging to place an implant in the optimal position for prosthetic restoration. In addition, the use of Bio-Oss as a bone filler to maintain the form of the edentulous ridge was evaluated. Nine patients were selected for the extraction of 36 maxillary anterior teeth. Nineteen extraction sockets received Bio-Oss, and seventeen sockets received no osteogenic material. All sites were completely covered with soft tissue at the conclusion of surgery. Computerized tomographic scans were made immediately following extraction and then at 30 to 90 days after healing so as to assess the fate of the buccal plates and resultant form of the edentulous sites. The results were assessed by an independent radiologist, with a crest width of 6 mm regarded as sufficient to place an implant. Those sockets treated with Bio-Oss demonstrated a loss of less than 20% of the buccal plate in 15 of 19 test sites (79%). In contrast, 12 of 17 control sockets (71%) demonstrated a loss of more than 20% of the buccal plate. In conclusion, the Bio-Oss test sites outperformed the control sites by a significant margin. No investigator was able to predict which site would be successful without the grafting material even though all were experienced clinicians. This leads to the conclusion that a patient has a significant benefit from receiving grafting materials at the time of extraction.

Sinus floor augmentation at the time of maxillary molar extraction: success and failure rates of 137 implants in function for up to 3 years.

BACKGROUND: Implant restoration of the posterior maxilla poses significant challenges to the clinician. In an effort to increase the apical occlusal dimension of available bone for implant placement, a number of sinus augmentation approaches have been suggested. This paper describes a simplified technique for predictable sinus augmentation at the time of maxillary molar extraction. METHODS: A modified trephine and osteotome technique was utilized to implode the interradicular bone following maxillary molar extraction. Particulate material and a membrane were then placed to maximize regeneration of alveolar bone. RESULTS: One hundred sixty-seven (167) implants were subsequently placed in regenerated bone following the above technique. One hundred thirty-seven (137) of these implants were restored and in function for up to 3 years at the time of statistical compilation, and 136 of the 137 implants were functioning successfully by the Albrekteson criteria for a cumulative success rate of 97.8%. CONCLUSIONS: The technique presented for simultaneous sinus augmentation at the time of molar extraction, followed by subsequent implant placement after maturation of regenerating tissues, demonstrates a high success rate for up to 3 years in function. Long-term studies may be useful in evaluating the continual efficacy of such an approach.

Sinus Floor Augmentation on at the Time of Maxillary Molar Extraction: Success and Failure Rates of 137 Implants in Function for Up to 3 Years.

BACKGROUND: Implant restoration of the posterior maxilla poses significant challenges to the clinician. In an effort to increase the apical occlusal dimension of available bone for implant placement, a number of sinus augmentation approaches have been suggested. This paper describes a simplified technique for predictable sinus augmentation at the time of maxillary molar extraction. METHODS: A modified trephine and osteotome technique was utilized to implode the interradicular bone following maxillary molar extraction. Particulate material and a membrane were then placed to maximize regeneration of alveolar bone. RESULTS: One hundred sixty-seven (1 67) implants were subsequently placed in regenerated bone following the above technique. One hundred thirty-seven (137) of these implants were restored and in function for up to 3 years at the time of statistical compilation, and 136 of the 137 implants were functioning successfully by the Albrekteson criteria for a cumulative success rate of 97.8%. CONCLUSIONS: The technique presented for simultaneous sinus augmentation at the. time of molar extraction, followed by subsequent implant placement after maturation of regenerating tissues, demonstrates a high success rate for up to 3 years in function. Long-term studies may be useful in evaluating the continual efficacy of such an approach. J Periodontol 2002; 73:3944.