From Conventional to Complex Treatments, Digital Technologies Are Simplifying Implant Dentistry.

In the past decade, the shifting of dentistry into the digital world has become obvious to any dentist or dental specialist. Many restorative dentists now consider themselves "digital dentists," performing all their crown and bridge restorative planning and fabrication in a digital environment. In preparation for this article, the author asked both a prosthodontist and the owner of a large state-of-the-art dental laboratory with whom he has worked closely the following questions: "These days, what percentage of your crown and bridge cases are being done fully digital?" Then, "What is the answer to the same question 5 years ago?" The prosthodontist answered that for crowns and bridges (with some exceptions for bridges), including implants (but not full arches), "close to 100 percent" of cases are now fully digital, while "maybe 25 percent" were 5 years ago (personal communication with Jason Sauer, DDS, of Westchester Prosthodontics, White Plains, New York, March 29, 2024). The dental laboratory owner answered, "My lab is different than others. We're about 60 percent digital, but digital is rapidly increasing. I'd say the majority of labs are 80 to 90 percent digital. Five years ago, we were 70 to 80 percent hand (analog.) We went from three mills pre-Covid to 30 different machines post-Covid (printers, mills, and scanners)" (personal communication with Steven Pigliacelli, MDT, of Marotta Dental Studio, Farmingdale, New York, March 29, 2024). It's fair to say that these comments show that the implementation of digital technologies in dentistry has been dramatic and will continue to expand.

Elevoplasty®: An Innovative, Minimally Invasive Procedure for the Treatment of Snoring.

For non-obstructive sleep apnea diagnosed patients with predominantly palatal snoring, Elevoplasty® is an efficient, minimally invasive treatment option. Aimed at reducing snoring severity, the innovative procedure involves the placement of three to four small resorbable polydioxanone barbed sutures, which are buried in the tissues of the soft palate. After placement, the sutures are "activated" by a gentle pull, which provides a "lift" of the soft palatal tissues and uvula. The soft palate, thus, is moved off of the posterior pharyngeal tissues at the back of the throat, providing an increased opening of the posterior pharyngeal airway and a reduction in snoring severity. This article provides an overview of this procedure along with other treatments for snoring.

Coronectomy: An Alternative to Complicated Full-Bony Impacted Tooth Removal.

The removal of impacted teeth is a common office-based oral and maxillofacial surgical procedure. Complications associated with the procedure are uncommon; however, in the mandible, close proximity of the third molars to the inferior alveolar nerve can potentially lead to temporary or permanent sensory disturbances. The intentional partial odontectomy (coronectomy) procedure is a surgical option aimed at mitigating and reducing the incidence of this potential risk and complication.

Is a Fully Digital Dental Implant Treatment Solution a Real Possibility in 2020?

Digital implant workflows are facilitating new and more accurate methods of implant treatment planning when compared to conventional analog techniques. The placement of implants using guided surgery presents multiple benefits for immediately restoring a patient functionally and esthetically with a provisional restoration. Although digital technology enables efficiency and enhanced accuracy for dental implant treatments, some cases may require the use of a hybrid workflow that employs both conventional and digital procedures, as some limitations to a fully digital approach exist depending on the clinical situation. This article presents several different implant treatment scenarios and discusses whether a fully digital workflow is possible and/or beneficial in each situation. The scenarios describe the full-treatment sequence for immediately loaded implants, allowing a direct comparison of various restorative and surgical implant workflows.

Immediate Loading: Are Implant Surface and Thread Design More Important Than Osteotomy Preparation?

The design and development of today's dental implants has been an evolving process based on scientific research, clinician input, and manufacturer ingenuity. Newer tapered implants with aggressive thread designs allow for placement at greater torque values than in the past, with high levels of initial stability even in situations with low-density or compromised bone. Modern implants are designed for patient cases involving extraction, immediate placement, and immediate load, as well as cases with less-than-ideal bone volume and quality. Contemporary implant body and platform design strongly considers minimizing bone trauma and crestal bone loss while maintaining gingival architecture. Even the most advanced implant design, however, can only function well when the implant is placed in healthy surrounding bone. Current thought leans toward the notion that implant bed preparation is as important as the implant itself. This article discusses the rationale behind the influence of these modern-day factors in immediate loading and aims to assist clinicians in decision making regarding appropriate selection of implants, instrumentation, and clinical procedures.

Computer-Guided Dental Implant Treatment of Complete Arch Restoration of Edentulous and Terminal Dentition Patients.

The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized.

Ten Myths of Guided Implant Surgery.

Since their introduction, guided dental implant planning and surgery procedures, like most new techniques in medicine and dentistry, have undergone many modifications and advances. While some practitioners were early adopters, most dental surgeons have been cautious regarding this methodology. Despite more than a decade of literature, podium presentations, advances in instrumentation and technique, and successful cases, questions remain within the dental surgical community. This article attempts to address some of these by outlining common but erroneous beliefs about this technology and procedure.

What's Hindering Dentistry From the Widespread Adoption of CT-Guided Surgery?

Although computed tomography (CT)-guided technology has been shown to increase implant placement accuracy, decrease surgical complications, and improve the predictability of implant case outcome, many in the dental implant community continue to resist using it for three main reasons: time, money, and fear. While it is true that there are additional preparatory steps necessary in patient case planning and the practitioner must invest in unfamiliar technologies and overcome a learning curve, increased efficiency, improved restorative outcomes, and clear benefits to both patients and practitioners make a strong case for adopting this approach.

Cumulative survival rate of implants placed "fully guided" using CT-guided surgery: a 7-year retrospective study.

PURPOSE: To evaluate the cumulative survival rates (CSRs) of dental implants placed "fully guided" using computed tomography (CT)-guided surgery, including cone beam CT (CBCT). MATERIALS AND METHODS: Records, mountings, wax-ups, and scanning appliances were made for patients to wear during CT/CBCT scans following established manufacturer-guided surgery protocols. Virtual planning was performed using either the NobelProcera/NobelClinician or the SimPlant/Facilitate softwares. Manufacturer-produced stereolithographic guides and implant-specific instrumentation were used to place implants fully guided to planned depths and angulations. Included in the study were 177 patients, who had 796 implants placed fully guided, using 212 surgical guides. RESULTS: Among 796 implants placed, there were 24 failures, for a 96.98% CSR. System CSRs were: NobelActive, 95.87%; Astra OsseoSpeed, 96.72%; NobelReplace Select Tapered, 97.02%; and NobelReplace Select Straight, 100% (P less than 0.05). Maxillary CSR was 97.62%; mandibular CSR was 95.88% (P less than 0.05). CSR for standard implants (10 mm to 13 mm) was 97.3%; short implants (less than or equal to 9 mm) was 95.1% (P less than 0.05), and long implants greater than 13 mm) was 95.2%. Implant diameter CSR was not significant (P greater than 0.05) for any diameter implant. Full-arch immediately loaded CSR (97.18%) was not different compared to full-arch unloaded (97.20%) (P less than 0.05). CONCLUSIONS: 1) Fully guided implant CSR was 96.98%, which is comparable to "freehand" placement; 2) CSRs varied between implant systems; 3) fully guided short and long implants had lower CSRs than standard implants; 4) the diameter of fully guided implants did not affect CSR; 5) fully guided implants in the anterior maxilla and posterior mandible had reduced CSRs; 6) extraction/immediate placement using fully guided surgery had reduced CSRs; and 7) immediate loading fully guided implants did not affect CSRs.

Cavernous sinus thrombosis as a result of a fungal infection: a case report.

Cavernous sinus thrombosis (CST) is a rare disease with the potential for significant morbidity and even death. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. The cause may be aseptic or infectious. When the cause is infectious in nature, it is most commonly from a bacterial origin. However, we present the case of a 57-year-old man with a fungally related CST that ultimately led to his death.

Comparison of the accuracy of cone beam computed tomography and medical computed tomography: implications for clinical diagnostics with guided surgery.

PURPOSE: This study compared the accuracy of cone beam computed tomography (CBCT) and medical-grade CT in the context of evaluating the diagnostic value and accuracy of fiducial marker localization for reference marker-based guided surgery systems. MATERIALS AND METHODS: Cadaver mandibles with attached radiopaque gutta-percha markers, as well as glass balls and composite cylinders of known dimensions, were measured manually with a highly accurate digital caliper. The objects were then scanned using a medical-grade CT scanner (Philips Brilliance 64) and five different CBCT scanners (Sirona Galileos, Morita 3D Accuitomo 80, Vatech PaX-Reve3D, 3M Imtech Iluma, and Planmeca ProMax 3D). The data were then imported into commercially available software, and measurements were made of the scanned markers and objects. CT and CBCT measurements were compared to each other and to the caliper measurements. RESULTS: The difference between the CBCT measurements and the caliper measurements was larger than the difference between the CT measurements and the caliper measurements. Measurements of the cadaver mandible and the geometric reference markers were highly accurate with CT. The average absolute errors of the human mandible measurements were 0.03 mm for CT and 0.23 mm for CBCT. The measurement errors of the geometric objects based on CT ranged between 0.00 and 0.12 mm, compared to an error range between 0.00 and 2.17 mm with the CBCT scanners. CONCLUSIONS: CT provided the most accurate images in this study, closely followed by one CBCT of the five tested. Although there were differences in the distance measurements of the hard tissue of the human mandible between CT and CBCT, these differences may not be of clinical significance for most diagnostic purposes. The fiducial marker localization error caused by some CBCT scanners may be a problem for guided surgery systems.

Combining All-on-4 treatment with CT-guided technology: technique and report of three cases.

No longer merely a concept for the future, the use of digital technologies in dentistry has become common practice today. Computed tomography (CT)-guided dental implant surgery has greatly expanded over the past decade as concepts and techniques have become increasingly refined and more implant manufacturers have adapted their implant systems to these new technologies. The All-on-4® technique for dental implant placement and restoration, while developed some two decades ago, has recently generated increased interest as a highly functional, esthetic, cost-effective alternative for a large group of patients who could benefit from a full-arch, implant-supported fixed restoration. The authors ask, "Are these two technologies a marriage made in heaven?" This article describes the All-on-4 CT-guided surgery technique and reports on the treatment findings on three patients, each with different prosthodontic management.

Implant complications: biomechanical and esthetic considerations--a prosthodontist's perspective.

Implant placement has continued to gain acceptance as a viable solution for the treatment of missing teeth, serving as an alternative to dentures or bridges. However, clinicians must be aware of and capable of handling complications that may accompany the placement of dental implants. Complications can range from prosthetic problems stemming from misalignment of implants, to fixed removable prosthesis-related complications, to screw-connection impediments. This article describes and illustrates how a multidisciplinary team approach can be employed to optimize implant treatment planning to successfully overcome these issues.

Application and success of two stereolithographic surgical guide systems for implant placement with immediate loading.

PURPOSE: Two different stereolithographic surgical guide systems, NobelGuide (Nobel Biocare) and SimPlant (Materialise), were compared clinically, and the survival rates of the planned immediately loaded dental implants with prefabricated provisional restorations were evaluated. MATERIALS AND METHODS: Patients were treated with implants using either the Materialise SimPlant system or the Nobel Biocare system. All implants were planned on cone beam computed tomography (CBCT) or CT-derived images. Mucosa-, bone-, or tooth-supported stereolithographic guides were produced using the two commercial systems. A provisional was placed immediately after implant insertion in all cases. RESULTS: Fourteen patients were enrolled. Seventy-five implants were placed (34 with Materialise, 41 with Nobel Biocare) using stereolithographic surgical guides. All but one implant were loaded immediately with prefabricated provisionals. In all cases, implants were in place for a minimum of 12 months. No complications related to associated anatomy occurred. One implant failed, leading to a combined cumulative survival rate of 98.7%. There were no other intraoperative or postoperative complications. Implants placed by bone-supported guides had increased patient symptoms of postoperative swelling and discomfort. All provisionals were successful. CONCLUSIONS: Both types of stereolithographic surgical templates were sufficiently accurate in transferring the planned implant positions to the surgical field, allowing the placement of prefabricated provisionals. These technologies are most beneficial in patients in whom the simultaneous placement of multiple implants in combination with complex restorations is planned.