Implant placement without flaps--Part 2: Utilizing a two-stage surgical protocol.

The single-stage punch technique can provide an effective means of seating an implant fixture without necessitating flap elevation. As described in Part 1 of the article, when the implant must be submerged during the healing phase of osseointegration, the single-stage punch technique may be modified to permit the requisite isolation to be achieved. In this procedure, the mucosal tissue is removed with the soft tissue punch and reseated at the ridge site following the placement of the implant. The second part of the article utilizes two case presentations to demonstrate the proper use of the modified single-stage punch technique.

Immediate loading of modular transitional implants: a histologic and histomorphometric study in dogs.

Modular Transitional Implants (MTI) are made from pure titanium and are used to support fixed provisional restorations during the osseointegration of definitive implants. This study histologically examined the jaw response to loaded MTIs in the dog mandible. Three implants were inserted transmucosally into each side of the mandible in 3 dogs. Stability was examined using a Periotest. Anterior and posterior implants were splinted using a cemented acrylic resin fixed partial denture to allow immediate loading. The middle implant remained unloaded and was used as a control. Dogs were sacrificed 11 to 12 weeks after implantation, and tissue blocks containing the implants were removed. Histologic examination showed that 10 of the 18 implants had good bone-to-implant contact, with the percentage of bone contacting the threaded portion of the implant varying from 30% to 65%. There was no statistical difference (p > 0.1) in percentage of bone-to-metal contact between loaded and unloaded implants. Six implants were entirely surrounded by connective tissue with or without inflammation; two implants were lost during the study. The success rate did not differ between loaded and unloaded implants. In the successful implants trabecular bone made good contact with the implant, forming supporting struts. There was bone remodeling in some bone-to-metal contact areas. It is believed that success was mainly influenced by the initial bone density at the implant site and by the uncontrolled load that the animals applied to the implants during the early healing stage.

Implant placement without flaps: a single-stage surgical protocol--Part 1.

Osseointegrated implants have been demonstrated to be predictable, efficacious means of restoring aesthetics and long-term function to edentulous patients. Although the surgical and placement protocols for the use of implant therapy have continued to evolve, specific criteria must be addressed when utilizing this modality. The objective of this article is to describe the requisites for proper implant placement and demonstrate the use of a novel surgical protocol to insert implant fixtures in selected edentulous sites with a mucosal tissue punch rather than a conventional flap elevation procedure.

Papilla regeneration by noninvasive prosthodontic treatment: segmental proximal restorations.

Bonded segmental proximal restorations, whether direct or laboratory fabricated, can be added to selected aspects of a tooth utilizing the acid-etch technique with no macromechanical preparation. When properly executed the prosthetic supplements guide and support newly regenerated papillae in deficient interproximal aspects. Although they are overcontoured, the properly finished and polished convex intracrevicular areas of the restorations will not have adverse effects on the tissues. When overcontoured restorations are limited in the interproximal space, compression and relief of the gingival fibers results. Alternately, any overcontouring of the labial aspects might stretch and cause overtension to the gingival fibers and result in iatrogenic damage to the periodontal support structures. The controlled, intentional, overcontoured proximal restorations and the adjoining soft tissues can easily be maintained through regular oral hygiene measures, for healthy, long-lasting service.

Achieving optimal gingival esthetics around restored natural teeth and implants. Rationale, concepts, and techniques.

The role of prosthetic restorations in the final appearance of the surrounding soft tissues has long been recognized. Innovative prosthodontic concepts as described should be used to enhance the biologic as well as the esthetic data of the supporting tissues, in natural teeth and implants alike. Combined dental treatment modalities of different kinds (i.e., orthodontics, periodontal treatment) are often required for optimal results. Meticulous care and attention to the delicate soft tissues should be given throughout all phases of the treatment, with a view to achieving a functional, healthy, and esthetic oral environment.

Effect of combinations of surface treatments and bonding agents on the bond strength of repaired composites.

STATEMENT OF PROBLEM: Enhancement of bond strength between new and old composite usually requires increasing the surface roughness to promote mechanical interlocking and coating of old composite with unfilled resin bonding agents to advance surface wetting and chemical bonding. PURPOSE: The purpose of this study was to evaluate the effect of combinations of surface treatments and bonding agents on the shear bond strength between new and old composite. MATERIAL AND METHODS: Six surface treatments, two bonding agents, and an untreated control comprised 18 different subgroups. RESULTS: The use of unfilled resin, alone or combined with silane, was the most effective procedure to enhance the shear bond strength of the repaired composite specimens, irrespective of the surface pretreatment processes. Silanation and unfilled resin slightly but not significantly improved the repair strength compared with unfilled resin alone. CONCLUSIONS: Different combinations of surface treatments and bonding agents affect shear bond strength differently. The highest shear bond strength values were achieved by grinding the surface with green Carborundum stone or sandblasting, whereas the lowest values were obtained with hydrofluoric acid as the surface treatment agent.

Single implant restorations: prosthetically induced soft tissue topography.

An aesthetic transition from the smaller diameter of the implant to the prosthetic restoration that resembles the size of the natural tooth has presented an ongoing challenge to the implant restorative dentists. The appearance of the surrounding soft tissue is of major importance, and various techniques have been developed to guide and optimize its topography. The learning objective of this article is to present a cervical contouring concept, whereby the soft tissue topography is optimally determined already in the laboratory phase. Using a custom abutment and provisional crown as components of the transmucosal prosthetic unit (TPU), the topography is transferred to the vital intraoral tissues, which predictably adapt to the enhanced aesthetic configuration. Clinical cases are presented to demonstrate the sequence of the technique in treating the anterior region of the maxilla.

Direct composite resin restorations of the anterior single tooth: clinical implications and practical applications.

Modern technology has continued to improve composite resins to the point where they are commonly used in restorative dentistry. In spite of some drawbacks, such as polymerization shrinkage, incomplete conversion and cross-linking, and undesirable water sorption, the expected time of service of these restorations is extended continuously due to physical and chemical improvements. The improved handling and excellent optical properties of the latest generation of composite resins can provide the appearance of natural dentition. Sophisticated effects can be obtained through the use of direct intraoral applications of stratification techniques. This article discusses common indications for direct restoration of anterior teeth and their treatment in order to be biocompatible with the adjacent hard and soft tissues and to meet the requirements of form, function, and phonetics.

Cervical contouring concepts: enhancing the dentogingival complex.

The importance of the mucogingival complex in any restorative procedure has long been recognized, and various surgical and nonsurgical procedures have been developed to restore the compromised gingiva to its original health. The learning objective of this article is to review nonsurgical restorative techniques to manipulate the soft tissue surrounding the cervical aspect of the restored tooth into a more favorable contour. The techniques presented are applicable to direct and indirect restorations. Six case reports are used to illustrate the various clinical procedures. The techniques include: Supragingival direct restorative techniques, such as recontouring intact dentition; and intracrevicular indirect techniques, such as recapturing the soft tissue of deficient crown restorations, re-engineering recessed injured tissue, re-creation of hyperplastic injured tissue, re-engineering hyperplastic recessed posttrauma tissue, and re-engineering the periprosthetic envelope.

Porcelain laminates: integrated concepts in treating diverse aesthetic defects.

The materials and application techniques of porcelain laminates have characteristics unique to this particular treatment modality. When properly selected and utilized, these characteristics present certain advantages. The learning objective of this article is to review porcelain laminate applications in the treatment of diverse aesthetic defects. Particular aspects of the treatment, including recommended finish lines, peripheral priority technique in facial and incisal coverage design, combined treatments, and split pontic restorations are discussed. Several cases are used to illustrate the concepts presented.

Shear bond strength of composite resin to fresh amalgam.

The shear bond strength between fresh amalgam and composite resin using three adhesive systems was assessed. Amalgambond (5.19 MPa), All-Bond (3.45 MPa), and Clearfil New-Bond (4.37 MPa) had comparable shear bond strengths higher than Enamel Bond (1.27 MPa) after 48 hours of water immersion. This bond was hydrolytically degraded during 100 days of immersion in water. The greatest deterioration was observed for Clearfil New-Bond (0.81 MPa). Amalgambond provided the best results, whereas All-Bond and Clearfil New-Bond had comparable bond strength to Enamel Bond at the end of the experiment.

Options in aesthetic restorations: discoloration and malformation--problems and solutions.

This article is a review of the current options for treatment of discolored and malformed dentition--laminate veneers, all-ceramic crowns, and metal-ceramic crowns. It emphasizes the importance of close cooperation between the restorative dentist and the laboratory technician and a thorough knowledge of the dental materials science. The objective of this article is to provide diverse solutions for severe tooth discolorations and malformations. Four cases illustrate the procedures, the materials utilized, and the results achieved.

A modified surgical/prosthetic approach for an optimal single implant-supported crown. Part II. The cervical contouring concept.

Achieving an aesthetic implant-supported restoration is a constant challenge for the restorative dentist. Part I of this article, published in the March, 1994, issue of PP&A, presented a modified regenerative technique--the "socket seal surgery" (SSS). Part II presents a modified prosthetic technique--the "cervical contouring concept" (CCC). The clinical and laboratory prosthetic procedures are covered in four steps, reshaping of the gingival profile is discussed, and a case report is used to illustrate the procedures. The learning objective of this article is to supplement reader knowledge of methods and techniques in prosthodontic procedures.

The centripetal build-up for composite resin posterior restorations.

The paper introduces a new technique for creating Class II posterior composite restorations--the centripetal build-up. This technique replaces the lost tooth structure from the periphery towards the center of the cavity, thereby achieving better marginal adaptation to the gingival floor. Since overfilling is rare, rotary finishing is minimized. This method allows the creation of long-term aesthetic posterior composite restorations, while utilizing conventional auxiliary (ie, metal matrix bands and wooden wedges) in operative dentistry. The learning objective of this article is to introduce this new technique to a wider segment of the dental profession.

A modified surgical/prosthetic approach for optimal single implant supported crown. Part I--The socket seal surgery.

Optimal implant placement can be achieved only if the ridge maintains its dimensions and the quality of bone. To prevent the resorption of the ridge and to enhance the quality of regenerated bone, two main approaches have been suggested. Part I of this article presents a modified regenerative technique-the "socket seal surgery" (SSS). Part II will present a modified prosthetic technique--the "cervical contouring concept" (CCC)--and it will be published in the May, 1994, issue of PP&A. The learning objective of this article is to supplement reader knowledge of methods and techniques for prevention of ridge resorption and enhancement of bone regeneration.