The Poncho Lamina Technique: A Protocol for Hard and Soft Tissue Augmentation in Atrophic Ridges Receiving Adjacent Implants.

The current scientific knowledge and guidelines in bone and soft tissue augmentation suggest the use of staged surgical workflows as the gold standard of regenerative procedures during implant therapy. In this context, the process is always the same, regardless of the techniques applied: an alternate series of surgical acts that follow one another after the completion of a specific period of osseointegration or graft maturation. As a result, the overall surgical treatment is often long and invasive and induces scar tissue formation. This article proposes a novel, fast, and less-invasive biphasic protocol with the use of a well-documented cortical barrier mounted on healing screws that are further replaced by customized abutments at an early second stage. Two cases are reported, one for an upper maxillary edentulous area and the other for a mandibular, with a total of four implants placed. The results at 4 months postop showed an optimal soft tissue configuration for both cases, with adequate cervical profile generation and a sufficient supracrestal complex height above the implant platforms. Significant bone gains were also recorded through CBCT data collection, either with alveolar width measurements on axial slices, the superposition of pre-op and post-op datasets, or 3D visualization after bone volume segmentation.

Marginal Bone Level Evaluation of Fixed Partial Dental Prostheses Using Preformed Stock versus CAD/CAM Customized Abutments.

Background: The maintenance of marginal bone levels around dental implants is an important criterion for evaluating the success of implants. Although computer-aided design/computer-aided manufacturing (CAD/CAM) customized abutments (CAs) provide more flexible solutions, compared with the original preformed stock abutments (PAs), there are dimensional tolerances and underlying drawbacks in the production of CAD/CAM CAs, which may change the tightness and seamless connection between fixtures and abutments set by the manufacturer and then affect the long-term stability of the abutments. This study aimed to examine the change in both mesial and distal bone levels using digital periapical radiographs to evaluate the difference between CAD/CAM CAs and original PAs.Material and methods: Radiographs were taken before delivery; after functional loading for 1 month; and after 3, 6, and 12 months; and the vertical marginal bone levels (vMBLs) of both the mesial and distal surrounding implant bones were measured. All data are presented as means ± standard errors and were analyzed using Student's t-test. A p-value < 0.05 was judged to represent a significant difference. Results: A total of 57 implants in 50 patients were divided into 22 CAD/CAM CAs and 35 original stock abutments. The PAs appeared to have a more stable bone level. By contrast, the amount of bone level change in the CAs was higher than that in the PAs. The change in the vMBL of the CAs was significantly more than that of the PAs after functional loading for 1 month (p = 0.006), 3 months (p = 0.013), 6 months (p = 0.014), and 12 months (p = 0.002). In contrast, the distal marginal bone level was lower than the mesial marginal bone level in any period. Nevertheless, the bone levels of the CAs and PAs in any period were comparable with no significant difference. Conclusions: Significant differences were found between the mesial and distal bone levels in the PAs. The CAD/CAM CAs showed a significantly greater bone level change than the original stock abutments after functional loading.

Influence of different combinations of CAD-CAM crown and customized abutment materials on the force absorption capacity in implant supported restorations - In vitro study.

OBJECTIVES: To evaluate the force absorption capacity of implant supported restorations utilizing different CAD-CAM materials for the fabrication of crowns and customized abutments. METHODS: 80 titanium inserts were scanned to design customized abutments and crowns. The specimens were divided into four groups (n = 20/material): (Z): zirconia, (P): PEEK, (V): VITA Enamic, and (E): IPS e.max. Each group was subdivided into two subgroups according to customized abutment material: (Z) zirconia, and (P) for PEEK. For the assessment of force absorption, all specimens were loaded in a universal testing machine, applied loads curves were collected from the machine's software, and resulting loads curves were collected from forcemeter below the assembly. The slopes of all curves were analyzed using Two-way multivariate analysis of variance with pairwise comparisons using Tukey Post Hoc test (p < 0.05). RESULTS: The curve progression of the applied and resulting forces varied among the investigated materials for each specimen. For zirconia abutments, ZZ showed the highest slope values of the applied and resulting force curves, followed by EZ, VZ, and PZ demonstrating statistically significant differences (P < .001). As for PEEK abutments, ZP and EP showed the least slope values, followed by PP then VP demonstrating statistically significant differences (P < .001). For Zirconia and e.max crowns, using PEEK abutments significantly increased slope loss. As for PEEK and Vita Enamic crowns changing abutment material did not significantly affect slope loss. SIGNIFICANCE: Combining rigid crown materials with less rigid abutments might enhance their force absorption capacity. However, with less rigid crown materials a stiff substructure might be mandatory to preserve their force absorption behavior.

Monolithic restorations on customized titanium abutments - a cast-free approach without the necessity of gingiva management for impression taking.

The present application report describes a cast-free and chairside workflow that enables the manufacturing of monolithic restorations on custom-made abutments without damaging the periimplant soft tissue for impression taking. An easily achievable checklist for the individualization of standard abutments is presented so that the shape of the abutment is compatible with especially developed software after optical impressions. The principle of the method contains an extraoral impression of the finish line of the abutment and an intraoral impression that indicates the abutment position in relation to the adjacent teeth. The software needed for the semi-automated registration of the intra- and extraoral impression operates with .stl data and can be provided by the corresponding author on request.

Implantes adjacentes nas posições dos incisivos centrais maxilares: caso clínico com 18 meses em função / Adjacent dental implants in the central incisor's positions: a clinical case with 18 months of function

Implantes adjacentes na região anterior constituem um verdadeiro desafio para a Peri-Implantodontia estética. São diversas variáveis a serem analisadas, e a principal está em preservar a arquitetura tecidual pré-existente. Neste artigo, são discutidas as variáveis mais importantes e é apresentada uma sequência de tratamento de dois implantes osseointegrados adjacentes na região de centrais, cirurgicamente muito conservador e bem planejado, o que possibilitou um resultado estético final extremamente harmônico e natural.

Adjacent implants in the anterior region are a real challenge to esthetic Perio-Implantology. There are several variables to be analyzed, and the main one is preserving the pre-existing tecidual architecture. In this article we discuss the more important variables and present a treatment sequence of two adjacent osseointegrated implants at the central incisor's positions, surgically very conservative and well planned, which made possible an extremely harmonic and natural esthetic outcome.

Pilares personalizados y sistemas cerámicos con tecnología CAD-CAM en el manejo estético del sector anterior sobre restauraciones implanto soportadas. Reportes de casos / Customized abutments and ceramic systems with technology CAD-CAMin the aesthetic management of the previous sector on restorations implant supported. Reports of cases

En el presente reporte se describen 03 casos clínicos de rehabilitación sobre implantes unitarios en el sector anterior: 01 sist. Lifecore-Renova (3,75 mm Ø, 13 mm. longitud, conexión interna), 02 del sist. Conexão (5 mm Ø x 13 mm. de longitud; 4,3 mm Ø x 15 mm. de longitud, conexión interna). En la etapa de provisionales, se realizó manejo de tejidos blandos a través de restauraciones atornilladas provisionales (6-8 meses). En la rehabilitación definitiva se rehabilitaron, mediante el uso de: un pilar anatómico personalizado de oro-paladio y dos metalo-cerámicos; la parte coronaria fue restaurada con una corona metal-free de zirconio sistema Everest, y dos del sistema E-Max CAD (disilicato de litio).

The aim of the present article is to describe of 03 clinical cases of rehabilitation on unitary implants in the previous sector: 01 sist. Lifecore-Renova (3.75 mm Ø, 13 mm. length, internal connection), 02 of the sist.Conexão (5 mm Ø x 13 mm. of length; 4.3 mm Ø x 15 mm. of length, internal connection). In the stage of provisionals, there was realized managing of soft tissue across screwed provisional restorations (6-8 months). In the definitive rehabilitation they recovered, by means of the use of: anatomical customized abutments of gold - palladium (1) and metalo-ceramic (2); the coronary part was restored by crowns metal-free of zirconio system Everest (1), and 02 of the system E-Max CAD (disilicato of lithium).