Predictable Rehabilitation of Bone Deficiencies: Hygiene, Functional and Aesthetic Perspectives.

The aim of this article is to describe a method for correcting bone deficiencies which may compromise aesthetic, functional or oral hygiene maintenance of implant supported restorations. The generic causes of these deficiencies are mentioned. The use of autogenous block bone grafts is described alongside methods for managing the hard and soft tissues at both the recipient and donor sites. The biomechanical advantage conferred with the use of grafts in reducing the crown:implant ratio is emphasised. The sources of intraoral bone grafts are identified and the risks of damage to adjacent anatomical structures and their avoidance are addressed.The principles of healing are briefly described with an emphasis on the increasing predictability of contact healing, as opposed to gap healing.The impact and inherent risks associated with the supplementary use of membranes for containment is also addressed.Clinical cases have been used to illustrate procedures and outcomes. Previously published data is referenced.

Immediate Replacement of Single Teeth With Immediately Loaded Implants: Retrospective Analysis of a Clinical Case Series.

INTRODUCTION: The purpose of this retrospective analysis of clinical data was to evaluate the predictability of replacing failing single teeth with immediately placed implants loaded via a transitional (provisional) restoration. MATERIALS AND METHODS: Implants were placed immediately at the time of extraction of failing single teeth that met predetermined inclusion criteria. A detailed protocol was followed to enable immediate loading of the implant with the use of prefabricated abutments in combination with transitional restorations. RESULTS: A total of 375 immediate implants had been placed in 274 patients and loaded immediately. With the certainty of 95%, an estimated overall mean survival rate better than 97.6% was observed after a mean observation period of 36 months. The maximum observation period was 142 months. Four implants had been lost in function. CONCLUSION: Immediate loading of immediately placed implants is a possible treatment option that might be predictably and successfully achieved. Implants of adequate primary stability coupled with a range of prefabricated abutments permit function to be achieved using transitional restorations. The preliminary results of this clinical case series are very promising.

Clinical record-keeping for monitoring treatment outcomes in implant dentistry: a case study.

Sound clinical practice in implant dentistry depends upon defining the methodology that can successfully be used. This can be achieved by identifying literature relating to a specific technique prior to its use. However, clinical observations of outcomes within one's own practice are also very effective. This is particularly true as it becomes specific, by eliminating numerous confounding factors. Appropriate documentation, both clinical and radiographic, permits the practitioner to review clinical cases and establish the efficacy of the methodology used. This is most effective in terms of evaluating survival as well as determining aesthetic and functional outcomes. Software programs such as ImpDAT (Kea Software, Poecking, Germany) provide a platform that easily allows both accurate record-keeping and, importantly, retrieval of data for purposes of review and publication. This paper presents a case report that uses radiographic and photographic records to monitor the ongoing response of the patient to the specific treatment that was carried out; in this case, autogenous onlay bone grafts for the management of congenital partial anodontia.

Managing the edentulous mandible using recent technological developments: a case study.

Safe clinical practice in implant dentistry requires an accurate investigation of the availability of bone for implant placement and the avoidance of critical anatomical structures. Modern imaging techniques using computed tomography (CT) and cone beam computed tomography (CBCT) provide the clinician with the required information. The imaging thus obtained provides accurate representation of the height, width and length of the available bone. In addition, whenever adequate radiation dose is used, accurate information about the bone density in Hounsfield units can be obtained. Important spatial information regarding the orientation of the ridges and the relationship to the proposed prosthetic reconstruction can be obtained with the aid of radiopaque templates during the acquisition of CT scan data. Modern software also provides the facility to decide interactively upon the positioning of the implants and is able to relate this to a stereolithographic model constructed from the imaging data. A surgical guide for the accurate positioning of the implants can be constructed. The construction of screw retained prostheses is fraught with difficulties regarding the accuracy of the construction. Accurate fit of the prosthesis is difficult to obtain due to the inherent errors in impression taking, component discrepancies, investing and casting inaccuracies. CAD/CAM technology eliminates the inaccuracies involved with the investing and casting of superstructures.

Thirteen-year follow-up study of resin-bonded fixed partial dentures.

OBJECTIVE: The technique of resin-bonded fixed partial dentures (RBFPD) is a well-accepted clinical technique to replace missing teeth. The survival rates reported in the literature vary widely, and the conclusions are sometimes conflicting. This study presents the clinical long-term performance of silicoated RBFPDs and also determines the main cause of failure. METHOD AND MATERIALS: Sixty-one patients with a total of 74 RBFPDs were either examined or requested to complete a questionnaire regarding their fixed partial dentures. Sixty-four were placed in the anterior region, and 10 in the posterior region. No more than one missing tooth in the posterior area and two missing teeth in the anterior region were replaced with RBFPDs. A retentive preparation was made on the abutment teeth. All the RBFPDs were adhesively seated. RESULTS: Eighteen RBFPDs failed after a mean observation time of 7.8 years (nine retention losses of one or more retainers, six carious lesions, and three veneer fractures occurred). Seven RBFPDs were rebonded, whereas the remaining 11 failures had to be replaced with conventional FPDs. Fifty-six RBFPDs were primary restorations, and seven secondary RBFPDs were used after the loss of the primary restoration. A mean survival rate better than 69% after a 13-year observation period was calculated. Including the rebonded restorations, a mean functional survival rate of 83% was estimated. A total of 18 failures (24.3%) of all restorations were observed, the main cause being loss of retention. CONCLUSION: Silicoated RBFPDs are a viable treatment means with an acceptable success expectancy.

Evolution of the concept of angulated abutments in implant dentistry: 14-year clinical data.

This paper describes the evolution of the concept of selecting the abutment at first-stage surgery and presents clinical data accumulated over 14 years of the use of this concept with angulated abutments. The concept was developed for implants using internal and external hexed connections and has evolved in its use for implants using a Morse taper connection as a result of the considerable clinical advantages that this type of connection offers. A total of 3101 implants were restored using angled abutments ranging from 0 to 45 degrees and were observed over a period of up to 151 months. After an observation time of 120 months (10 years) after placement, the calculated 95% confidence interval of the mean survival estimation, according to Aalen et al, was 98.2% (+/- 0.7%). The magnitude of the angles did not influence the survival rate. The need to refine the implant position in terms of the depth to which it was placed and the angulation and rotational orientation, as well as the size and pivot point of the final abutment, were recognized as contributing to the harmonious emergence profile of the restoration. Good esthetic and functional outcomes were achieved by the use of conventional cement-retained restorations made possible by parallel and aligned abutments.