Decision Tree for Vertical Ridge Augmentation.

Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patient-related factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.

Flap Designs for Flap Advancement During Implant Therapy: A Systematic Review.

PURPOSE: Guided bone regeneration (GBR) procedures allow ridge augmentation before or at time of implant placement. GBR outcomes rely on primary passive tension-free wound closure, which may be achieved by a variety of flap designs and surgical procedures. A comprehensive literature review of flap design and management is provided, including material types, incision design, reflection, releasing, and suturing techniques. MATERIALS AND METHODS: Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1990 to September 2015 published in the English language were considered. RESULTS: A variety of flap designs aim to achieve primary passive closure during GBR were introduced. To facilitate case selection and treatment planning, flap designs have been categorized based on their ability to achieve minor (<3 mm), moderate (3-6 mm), and major (≥7 mm) degrees of flap advancement. CONCLUSIONS: Techniques such as vertical releasing incisions, periosteal releasing incisions, and split-thickness flaps may be used alone or combined to achieve passivity during GBR. GBR complications may be prevented by imaging and preoperative planning and careful surgical technique especially flap advancement.

The Role of Occlusion in Implant Therapy: A Comprehensive Updated Review.

PURPOSE: Occlusal overload may cause implant biomechanical failures, marginal bone loss, or even complete loss of osseointegration. Thus, it is important for clinicians to understand the role of occlusion in implant long-term stability. This systematic review updates the understanding of occlusion on dental implants, the impact on the surrounding peri-implant tissues, and the effects of occlusal overload on implants. Additionally, recommendations of occlusal scheme for implant prostheses and designs were formulated. MATERIALS AND METHODS: Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1950 to September 20, 2015 published in the English language were considered. RESULTS: Recommendations for implant occlusion are lacking in the literature. Despite this, implant occlusion should be carefully addressed. CONCLUSION: Recommendations for occlusal schemes for single implants or fixed partial denture supported by implants include a mutually protected occlusion with anterior guidance and evenly distributed contacts with wide freedom in centric relation. Suggestions to reduce occlusal overload include reducing cantilevers, increasing the number of implants, increasing contact points, monitoring for parafunctional habits, narrowing the occlusal table, decreasing cuspal inclines, and using progressive loading in patients with poor bone quality. Protecting the implant and surrounding peri-implant bone requires an understanding of how occlusion plays a role in influencing long-term implant stability.

Tissue engineering for bone regeneration and osseointegration in the oral cavity.

OBJECTIVE: The focus of this review is to summarize recent advances on regenerative technologies (scaffolding matrices, cell/gene therapy and biologic drug delivery) to promote reconstruction of tooth and dental implant-associated bone defects. METHODS: An overview of scaffolds developed for application in bone regeneration is presented with an emphasis on identifying the primary criteria required for optimized scaffold design for the purpose of regenerating physiologically functional osseous tissues. Growth factors and other biologics with clinical potential for osteogenesis are examined, with a comprehensive assessment of pre-clinical and clinical studies. Potential novel improvements to current matrix-based delivery platforms for increased control of growth factor spatiotemporal release kinetics are highlighting including recent advancements in stem cell and gene therapy. RESULTS: An analysis of existing scaffold materials, their strategic design for tissue regeneration, and use of growth factors for improved bone formation in oral regenerative therapies results in the identification of current limitations and required improvements to continue moving the field of bone tissue engineering forward into the clinical arena. SIGNIFICANCE: Development of optimized scaffolding matrices for the predictable regeneration of structurally and physiologically functional osseous tissues is still an elusive goal. The introduction of growth factor biologics and cells has the potential to improve the biomimetic properties and regenerative potential of scaffold-based delivery platforms for next-generation patient-specific treatments with greater clinical outcome predictability.

Risks and benefits of connecting an implant and natural tooth.

PURPOSE: The purpose of this article was to review the current literature on the topic of tooth-implant supported fixed partial dentures (FPD) to determine risks and benefits for treatment planning considerations and weighing potential complications. MATERIALS AND METHODS: A PubMed search (April-August 2013) was performed using the keywords "tooth-implant fixed partial denture" and "tooth-implant bridge" in addition to manual searches of bibliographies of full text articles and related reviews from the electronic search. RESULTS: A total of 21 relevant articles were selected for inclusion in the topic of tooth-implant supported FPD. Although risks such as intrusion of the natural tooth existed when using tooth-implant FPD, however, current evidence supports its clinical usage. Nonetheless, to prevent potential complications, careful planning and prosthetic design are essential. CONCLUSION: Tooth-implant supported FPDs can have the similar success like conventional FPDs or implant-implant supported FPDs. However, careful planning and prosthetic reconstruction are required to ensure long-term success. Additional research is needed to gain a greater understanding of the biological and biomechanical factors affecting tooth-implant FPDs.