Benchmark performance of anodized vs. sandblasted implant surfaces in an acute dehiscence type defect animal model.

OBJECTIVES: Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration. MATERIALS AND METHODS: Histological and histomorphometrical analysis was performed to compare three implant groups, that is, (1) a novel, commercially available, gradient anodized implant, (2) a custom-made geometric replica of implant "1," displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing. RESULTS: The amount of newly formed crestal bone (BATA) around control groups (2) and (3) was significantly increased when compared to the test group (1) at the 8 weeks of healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming groups (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for groups (2) and (3) compared to (1). CONCLUSIONS: The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 1: assessment and management.

There remains debate as to whether, when there is a missing maxillary lateral incisor, space should be orthodontically opened to allow for prosthetic replacement or closed to camouflage the canines to substitute the absent lateral incisor by recontouring and simple restorative procedures. Each case presents its own features which will help decision making. Treatment planning these cases is multifactorial in nature and the decision ultimately depends on factors such as the malocclusion; inter-arch and intra-arch relationship; and canine properties (size, colour and shape). The ideal treatment is the most conservative one that satisfies the individual's aesthetic and functional requirements. Often, but not always, it is therefore space closure with camouflaging of the canines as lateral incisors. Multidisciplinary planning and delivery of care is essential and 'mandatory' in the delivery of optimal outcomes. The first part of this two-part series will discuss the principles of assessment, diagnosis and management. The second part will discuss the challenges encountered and possible solutions.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 2: challenges and solutions.

The developmental absence of permanent maxillary lateral incisors is a common developmental anomaly and presents clinical challenges. The maxillary lateral incisor is the second most common developmentally absent tooth after the mandibular second premolar, therefore can present frequently in practice. Patients with hypodontia of the maxillary lateral incisor present clinical challenges in relation to function and aesthetics. In part one of this two-part series, we focused on the assessment, diagnosis and management. In this part, we will discuss some of the frequently encountered challenges in canine camouflage cases and possible solutions.