Optimal placement of the two anterior implants for the mandibular All-on-4 concept.

The novelty of the All-on-4 concept for a mandibular implant-supported fixed dental prosthesis is the inclination of the posterior implants. Typically, the anterior implants are placed lingually relative to the canine/incisor teeth and perpendicular relative to the occlusal plane. According to the laws of elementary biomechanics, the long axis of the implant unit should be aligned to the axis of the occlusal loading forces during clenching in the maximal intercuspal position. When several implants are connected by a prosthesis, the mean axis of the overall occlusal loading must be taken into account. The objective of this report was to propose a different position for anterior implants by tilting them labially to counterbalance the distal inclination of the posterior implants.

A retrospective study of root coverage procedures using an image analysis system.

AIM: To investigate the efficacy of root coverage procedures and factors that may affect the clinical outcomes in non-experimental patients. MATERIAL AND METHODS: Two hundred and eighty-seven root coverage surgical procedures in 215 adult patients were evaluated retrospectively. Descriptive statistics were used to determine the patient profile. Comparisons between surgeries were assessed, and the impact of different parameters on the probability of mean/complete root coverage and gingival augmentation was explored. RESULTS: The mean percentage of root coverage was 72.29 (+/- 28)%. Complete root coverage was observed in 35.56% of the defects. The difference between the surgical procedures was not significant. The mean percentage of gingival augmentation was 106.18 (+/- 260)%. The difference between non-submerged grafts and the other techniques was significant (p<10(-3)). A significant negative impact of smoking, and maxillary teeth for both mean and complete root coverage were found. A significant positive impact of the tuberosity donor site was found for complete root coverage. Maxillary teeth and Miller's Class II and III were positive predictive factors for gingival augmentation. CONCLUSIONS: Under non-experimental conditions, root coverage procedures are effective. Smoking, maxillary teeth, donor site, and Miller's Classes are prognostic factors that may affect the results.

Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site.

BACKGROUND: The palatal masticatory mucosa is widely used as a connective tissue donor site in gingival recession treatment. However, concern has been raised regarding the potential risk of damaging the greater palatine artery (GPA) due to anatomical variations in the palatal vault. The anatomy of the palatal vault in terms of size and shape may affect the maximum dimensions of the graft that can be safely taken from the palatal vault. In a cohort of patients free of periodontal disease, the purpose of this study was to assess the maximum dimensions of the graft, particularly the height and length, that could be safely taken from the palatal vault. METHODS: Plaster impressions were made from 198 patients free of periodontal disease. Because the connective tissue graft is usually taken from an area extending from the mid-palatal aspect of the canine to the mid-palatal aspect of the second molar, this interval was measured and represented the maximum length dimension. The emergence of the GPA was assumed to be localized at the junction of the vertical and horizontal palatal walls of vault, and its course was marked on the plaster casts. The maximum height of the graft corresponded to the distances measured from the gingival margin to the marked course of the GPA of each tooth at its interproximal and mid-palatal aspects. RESULTS: The length of the maximum available tissue graft was 31.7 +/- 4.0 mm. The distance extending from the gingival margin to the greater palatine artery ranged from 12.07 +/- 2.9 mm at the canine level to 14.7 +/- 2.9 mm at the mid-palatal aspect of the second molar level. Therefore, in the premolar area, it was possible to harvest a connective tissue graft measuring 5 mm in height in all cases and 8 mm in height in 93% of cases. CONCLUSION: Our findings suggest that the maximum available tissue graft as measured in the palatal vault was large enough to allow a safe withdrawal from this donor site in a high percentage of our patient population free of periodontal disease.