An alternative method for restoring single-tooth implants.

BACKGROUND: Having laboratory technicians prepare soft-tissue casts and implant abutments with or without concomitant removable temporary prostheses during the restorative phase of single-tooth replacement is an accepted practice. It can, however, result in functional and esthetic intraoral discrepancies. CASE DESCRIPTION: Single-tooth implants can be restored with crowns (like those for natural teeth) fabricated at a dental laboratory on casts obtained from final impressions of prepared implant abutments. In the case reported, the restorative dentist restored the patient's single-tooth implant after taking a transfer impression. He constructed a cast simulating the peri-implant soft tissue with final impression material and prepared the abutment on this model. His dental assistant then fabricated a fixed provisional restoration on the prepared abutment. At the patient's next visit, the dentist torqued the prepared abutment onto the implant, took a final impression and inserted the provisional restoration. A crown was made conventionally at the dental laboratory and cemented in place at the following visit. CLINICAL IMPLICATIONS: This alternative method for restoring single-tooth implants enhances esthetics by more accurately simulating marginal gingival architecture. It also improves function by preloading the implant through fixed temporization after the dentist, rather than the laboratory technician, prepares the abutment to the dentist's preferred contours.

Peri-implant infections.

The most judicious way to address peri-implant disease is to take steps to avoid it from the beginning of each implant restoration case. This involves treatment planning with a priority placed on biomechanically overengineering the case, using sound surgical techniques, enhancing keratinized tissue prior to placing the implants when appropriate, and placing an emphasis on rigorous follow-up and hygiene instruction. In the long run, the benefits of adhering to such methods outweigh the disadvantages. Careful attention to these guidelines leads to a less stressful practice and fewer cases of peri-implantitis. It should also increase our dental implant success rates and predictability of outcome even further.

Techniques for ideal implant placement in the mandibular first molar position.

Implant restoration of the mandibular first molar can be particularly challenging because of the heavy occlusal force exerted on this tooth. Bone quantity and quality, as well as fixture characteristics, play important roles in the long-term success of any implant. In this article, techniques for the ideal placement of an implant in the lower first molar site are discussed for both abundant and moderate bone quantity and for bone quality that is either moderately or minimally dense. Placement depth and the benefit of using a commercially pure grade 4 titanium fixture for mandibular first molar restorations are also discussed. In cases where adequate supporting bone exists, wide-diameter implants can offer an advantage by anchoring the implant into more dense bone that is concentrated toward the outer edges of the underlying bone. These implants also provide greater surface area, which reduces the amount of force directed to the underlying bone and may increase the long-term prognosis of the implant.