Dental Cone-Beam Scans: Important Anatomic Views for the Contemporary Implant Surgeon.

Intraoral cone-beam computed tomography (CBCT), otherwise known as volume imaging CT scan, provides 3-dimensional images of mandibular and maxillary structures. These images offer highly accurate and valuable diagnostic information to facilitate treatment planning for implant cases. This article serves as a primer on how to read and interpret CBCT cross sectional views. It identifies anatomic structures of interest and discusses their clinical relevance.

Nerve damage related to implant dentistry: incidence, diagnosis, and management.

Proper patient selection and treatment planning with respect to dental implant placement can preclude nerve injuries. Nevertheless, procedures associated with implant insertion can inadvertently result in damage to branches of the trigeminal nerve. Nerve damage may be transient or permanent; this finding will depend on the cause and extent of the injury. Nerve wounding may result in anesthesia, paresthesia, or dysesthesia. The type of therapy to ameliorate the condition will be dictated by clinical and radiographic assessments. Treatment may include monitoring altered sensations to see if they subside, pharmacotherapy, implant removal, reverse-torquing an implant to decompress a nerve, combinations of the previous therapies, and/or referral to a microsurgeon for nerve repair. Patients manifesting altered sensations due to various injuries require different therapies. Transection of a nerve dictates immediate referral to a microsurgeon for evaluation. If a nerve is compressed by an implant or adjacent bone, the implant should be reverse-torqued away from the nerve or removed. When an implant is not close to a nerve, but the patient is symptomatic, the patient can be monitored and treated pharmacologically as long as symptoms improve or the implant can be removed. There are diverse opinions in the literature concerning how long an injured patient should be monitored before being referred to a microsurgeon.

Utilization of d-PTFE Barriers for Post-Extraction Bone Regeneration in Preparation for Dental Implants.

Guided bone regeneration (GBR) can be used to restore a defective alveolar ridge after extractions before or in combination with implant placement. It may also be employed after extractions to reduce crestal bone resorption and maximize bone fill of sockets. Resorbable or nonresorbable barriers (eg, expanded polytetrafluoroethylene [e-PTFE]) can be used when performing GBR procedures, but they need to be completely submerged to attain optimal results. Dense polytetrafluoroethylene (d-PTFE) is a type of nonresorbable barrier that circumvents the necessity to attain primary closure after placement of bone grafts, thereby reducing patient morbidity. This article addresses topics pertaining to d-PTFE utilization, including characteristics and advantages of d-PTFE barriers, time needed for osteoid tissue to become impervious to penetration by flap connective tissue, relevant clinical studies, and limitations of available data. Clinical photographs and radiographs of successfully treated cases are presented to illustrate the efficacy of d-PTFE barriers in regenerating defective bony plates after extractions.

A simplified impression protocol for fabrication of anatomical, cement-retained CAD/CAM abutments.

The complexity and labor-intensive nature of making implant-level impressions may inhibit some clinicians from recommending dental implant treatment. This paper describes a simplified impression technique for fabricating anatomical, cement-retained abutments without removing or inserting implant components. Using digitally coded healing abutments, this protocol bridges the gap between traditional impressions and computer-aided abutment manufacturing. Basic logistic considerations are reviewed, as well as other biomechanic and esthetic advantages, that should optimize overall treatment outcomes.