Transferring emergence profile and position of interim restorative implant fixture. A novel digital technique.

The present technical article describes a protocol to digitally reproduce the emergence profile of an interim implant prosthesis (IP) and to transfer its macrogeometry into the definitive restoration. The purpose of this protocol was to minimize alterations in the gingival architecture developed during the interim restorative phase of a single implant that could potentially jeopardize its esthetic outcome. The process included obtaining an intraoral scan with the interim IP in situ, a duplicate of this intraoral scan that was used to capture the exact position of the implant, and an extraoral scan of the prosthesis. These data could then be imported into IOS software to create a model where the patients' soft tissue was incorporated with precision, allowing for the fabrication of a definitive crown with an optimal soft tissue adaptation. As there are few articles in the scientific literature that have reported a consistent method to replicate the emergence profile of an interim IP, the present technical article aims to highlight the potential of utilizing the emergence profile of an interim IP created by IOS software.

Guided Bone Regeneration: Novel Use of Fixation Screws as an Alternative to Using the Buccoapical Periosteum for Membrane Stabilization With Sutures-Two Case Reports.

Guided bone regeneration (GBR) requires a stable graft-membrane complex. This article presents a novel technique that uses membrane fixation screws to serve as anchors for membrane stabilization sutures without the need for periosteal dissection and biting of the buccoapical periosteum. This technique may be a viable alternative when there is a preference to avoid the complexities of periosteal suturing and direct membrane fixation using tacks or screws. The technique, which utilizes anchoring screws as mooring lines, can be used at the time of tooth extraction as well as for ridge augmentation of an edentulous site in preparation for future dental implant placement. Two case reports are presented that illustrate the feasibility of the technique, in which the integrity and stability of a resorbable membrane is preserved prior to final closure, suggesting that screws used as anchors for stabilization sutures might be a predictable option when addressing challenging horizontal defects requiring GBR.

Use of a Sugar-Crosslinked Collagen Membrane in Conjunction With a Dehydrated Amnion/Chorion Membrane for Guided Bone Regeneration Around Immediate Implants.

Several bioabsorbable membranes have been proposed to exclude soft-tissue ingrowth and to stabilize the bone graft when guided bone regeneration (GBR) is performed. The properties of the various membranes differ slightly due to variances in composition and manufacturing processes affecting their handling and suitability for specific techniques. The aim of this article is to present a technique to perform GBR with the use of a sugar-crosslinked absorbable collagen membrane in conjunction with a dehydrated amnion/chorion membrane (dHACM). This technique can be used to perform GBR at the time of tooth extraction and for ridge augmentation of an edentulous site in preparation for future dental implant placement. The use of a collagen membrane in combination with a dHACM can facilitate stabilization of the bone graft and membrane by providing the benefits of a long-lasting bioabsorbable collagen membrane in addition to the unique benefits of an amnion/chorion membrane, which has been shown to provide growth factors to the surgical site that have potential to enhance regenerative outcomes.

Flapless Extraction Socket Healing Around an Immediate Implant Placed into a Mandibular Molar Site Without the Use of Regenerative Materials: A Case Report.

The aim of this case report is to expand on previous studies of flapless immediate implant placement in sites with a large gap distance, without the application of regenerative materials. In this case report, an immediate implant was placed in a fresh molar extraction site with a large gap distance from the implant surface to the socket walls without the use of a bone graft, membrane, or coronal flap advancement for primary closure. Clinical healing was consistent with spontaneous extraction socket healing. Uncovery at 3 months revealed complete socket fill and secondary stability of the implant. After 2 years and 2 months, bone levels remain stable. This case report demonstrates the natural healing potential of an extraction socket, which can provide sufficient bone healing and dimensional stability for implant osseointegration and a functional restoration.

A modified ridge Expansion technique in the maxilla.

Localized ridge expansion of a deficient edentulous maxillary alveolar ridge segment is a useful technique when the goal of surgery is to provide an increase in ridge width as a means of establishing an adequate alveolar crest capable of receiving endosseous implants. The purpose of this article is to describe several modifications to the original ridge-splitting technique for deficient maxillary ridges. These modifications include full-thickness flap reflection, elimination of vertical intraosseous incisions, and simultaneous incorporation of guided bone regeneration. The modifications help to decrease complications associated with the original ridge-splitting technique while increasing the predictability of ridge augmentation in the buccal-palatal dimension. A case is presented that demonstrates the efficacy of the modified technique.

Titanium mesh as an alternative to a membrane for ridge augmentation.

PURPOSE: The purpose of the present study was to determine the rate and extent of complications associated with using titanium mesh for bone regeneration and to identify which factors might be associated with postoperative complications, such as infection, soft tissue exposure, and graft failure. MATERIALS AND METHODS: A retrospective study design was used to analyze the treatment outcomes of 27 consecutive surgical sites in the maxilla and mandible that were treated with bone grafting in conjunction with fixation of titanium mesh. The primary study variable was whether the surgical sites treated with titanium mesh presented with any postoperative complications such as exposure of the titanium mesh and/or graft failure. A secondary study variable was whether treatment with bone grafting and fixation of titanium mesh provided the necessary bone augmentation required for subsequent dental implant placement. The predictor variables of maxillary versus mandibular surgical site and the type of bone graft material used were studied to determine whether any relationship exists between these variables and the aforementioned postoperative complications. RESULTS: A total of 27 consecutive sites in the maxilla and mandible that required substantial bone augmentation and were treated with titanium mesh were evaluated for 6 to 24 months after surgical treatment. Exposure of titanium mesh was seen in 7 (26%) of the 27 surgical sites evaluated. No significant difference in the exposure rate was seen between the maxilla and mandible or according to the type of graft material used. All 69 implants placed were in function, and the success rate was 100%. CONCLUSIONS: The findings from the present study indicate that substantial bone augmentation can be achieved using titanium mesh in conjunction with bone grafting. Furthermore, exposure of titanium mesh during healing does not necessarily compromise the final treatment outcome.

Introduction to the SES technique: a composite of surgical modifications which simplify the subepithelial connective tissue graft technique.

The subepithelial connective tissue graft has been a successful procedure when the primary goal of surgery is to obtain root coverage. A multitude of authors have described variations of the original technique that have the potential to decrease morbidity and increase the overall success of the procedure. This article describes the SES modifications, which consist of scooping horizontal incisions, elevating an envelope flap, and closing with a sling suture. Several cases demonstrate the potential of the SES technique to facilitate the connective tissue graft procedure.