Digital full arch implant supported Poly (methyl Methacrylate) interim prosthesis: a practice-based cohort study on survival and quality of life.

PURPOSE: Digitally planned and manufactured PMMA for full arch implant supported immediate loading interim prosthesis are becoming popular comparing with conventional acrylic prosthesis. Studies on prosthodontic performance and patient related outcomes are scarce but needed. The purpose of this study was to evaluate the clinical survival and impact on oral health related quality of life of immediate loading implant supported full arch CAD-CAM milled PMMA interim rehabilitations. METHODS: This was a practice based prospective cohort study performed in a Portuguese dental clinic. Eleven patients received a total of seventeen CAD CAM full implant-supported, screw-retained, full arch rehabilitation with milled PMMA and were followed up for 1 year. Primary outcome was Prosthesis survival determined with a modification of the California Dental Association score and a Kaplan Meyer survival function analysis. Secondary outcome was patient's quality of life as defined by application of the OHIP 14 PT questionnaire and standardized effect size variation between two visits. Significance was set at 5%. RESULTS: Survival probability at 12 months was 76%, complete fracture of the prosthesis occurred in 17,6 % of the cases and small fractures without lab involvement in 5,9%. There was a significant improvement in oral health related quality of life between visit 1 and 4. Mean difference and effect size for total OHIP-14 PT score were -32.91 (± 3.68 SD) and 3.66 (95% CI -1.83 to -5.80) P < 0.001* Wilcoxon matched paired rank test. CONCLUSIONS: Full arch implant supported CAD-CAM milled PMMA interim prosthesis seems a viable approach with good survival rate and great impact on patient's oral health related quality of life.

The expanded mesh free gingival graft: A novel approach to increase the width of keratinized mucosa.

BACKGROUND: The importance of an adequate amount of peri-implant keratinized tissue and attached mucosa has recently been emphasized. This manuscript presents preliminary findings of a novel approach for increasing the width of keratinized mucosa (KM) around dental implants using a mesh free gingival graft (mesh-FGG). METHODS: Two healthy adults were treated as part of this study. After implant placement, a large edentulous alveolar ridge with shallow vestibule and minimal amount of KM was treated in both subjects (one in the posterior mandible and the other in the anterior mandible) with the combination of an apically positioned flap and a mesh-FGG. Clinical, esthetic and patient-reported outcomes were observed at approximately 4-month time points. RESULTS: All sites healed uneventfully after the treatments. In both cases, increased vestibule depth, soft-tissue thickness, and width of peri-implant KM were obtained. The patients did not report any accessory discomfort. Four months following the grafting procedure, good overall esthetic outcome was observed with minimal color disparity and graft demarcation. CONCLUSIONS: Width of KM around dental implants can be increased using a mesh-FGG. Randomized controlled clinical studies comparing mesh-FGG to conventional FGG and other commonly applied techniques are required to assess the long-term efficacy of this novel technique in terms of soft-tissue thickness, width of peri-implant KM, and patient-reported outcomes. KEY POINTS: Principal Findings: Meshed-FGG allowed an expansion of the length of the harvested graft. This results in coverage of large recipient sites, increase in height of KM and good aesthetic integration of the graft.

The Trapezoidal Sling Suture: A Technical Note of a Novel Suturing Technique for Tunneling Flap Procedures.

The aim of this report is to describe a new sling suturing method with papillary anchorage that is found clinical applicable within the available conventional tunneling root-coverage procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, it ascertains a firm and stable connection for the entire bucco-gingival-graft complex into the horizontal and vertical dimension of both single and multiple recession defects. This technical note described the "trapezoidal sling suture" technique, that allows fixation and stabilization for graft and flap around both natural teeth and implants.

Comparison of two different techniques for deepithelialization: a split-mouth case series.

AIM: The aim of the present preliminary study was to observe and make a histologic comparison of connective tissue grafts (CTGs) harvested from the lateral palatal mucosa through the use of two different harvesting techniques. MATERIALS AND METHODS: Three patients were enrolled in the study, providing six standardized CTGs. One well-experienced periodontist collected the replacement grafts using two different methods. After outlining the grafts to a fixed dimension, the graft on one side was deepithelialized by a round coarse bur intraorally before harvesting. The graft on the contralateral side was obtained by harvesting from the palate first; subsequently, deepithelialization was performed extraorally with the aid of a no. 15c blade. After finalization, histologic evaluation was performed. RESULTS: No apparent differences were found between the two observed techniques in terms of graft thickness, proportion, and composition. After deepithelialization, epithelial remnants were clearly evident in five out of six cases. Despite being more technique sensitive, the removal of epithelium by bur scored better. Proper graft handling and graft regularity are described as advantages of the more conventional epithelial excision by blade. CONCLUSIONS: Despite the wide use and broad variety of commonly applied techniques of graft deepithelialization, the present authors assume that full excisions with the use of a blade are hardly ever achieved. Despite the unpredictable retrieval of epithelium by blade, graft handling and graft regularity can be proposed as the biggest advantages. On the other hand, the presented novel in situ deepithelialization with a round bur seems to be more predictable.

Multidisciplinary design: Creating a common perspective in complex cases.

OBJECTIVE: This clinical report describes and illustrates digital treatment planning and interdisciplinary orthodontic, surgical, and prosthetic treatment in a highly complex clinical case. CLINICAL CONSIDERATIONS: Analogue design protocols through wax ups are highly variable, technique sensitive, and operator dependent. Digital smile design and treatment planning tools facilitate simplified processes through the use of natural tooth libraries, based on the specific esthetic and functional needs of the individual patient. The vast information compiled in the virtual patient and the treatment plan consolidated in the initial digital design facilitate true interdisciplinary treatment planning and execution, with all dental specialties involved, from orthodontic to surgical and prosthetic treatment. CONCLUSIONS: Digital protocols and design tools provide clear clinical roadmaps for increased efficiency, precision, and predictability, vastly improving the quality of interdisciplinary patient care. CLINICAL SIGNIFICANCE: While analogue protocols are technique sensitive and largely dependent on the operator, digital smile design, and treatment planning tools offer opportunities for truly patient-centered individualized care and interdisciplinary treatment.

Combination of cone beam computed tomography and CAD-CAM techniques for maintaining natural emergence profile in immediate extraction and/or implant placement and restoration of a central incisor: A dental technique.

For immediate extraction and implant placement, preservation of the natural emergence profile is essential to optimize esthetics. In the technique presented, the Digital Imaging and Communications in Medicine (DICOM) and standard tessellation language (STL) data were merged to simulate the tooth before surgery and to design the interim restoration. The existing tooth and gingival architecture were replicated.

Mechanical, biological and clinical aspects of zirconia implants.

The objective of this narrative overview is to discuss several in vitro and in vivo studies regarding the performance of one-piece zirconia implants in combination with the description of two clinical scenarios where zirconia implant prototypes were utilized with emphasis on the possible scientific and clinical concerns that may affect the functional, biological and esthetic long-term outcomes.

Soft tissue stability at the facial aspect of gingivally converging abutments in the esthetic zone: a pilot clinical study.

STATEMENT OF PROBLEM: The literature indicates that 0.5 to 1.5 mm of gingival recession most often occurs within the first months after implant placement or abutment connection. PURPOSE: The purpose of this pilot study was to evaluate the effect of a concave transmucosal profile on the vertical stability of soft tissues at the facial aspect of dental implants. MATERIAL AND METHODS: Fifty-four implants were placed in esthetically demanding sites in 41 patients (17 women, 24 men; age range of 23 to 62 years, mean 40.3 years; 5 smokers), primarily following a 1-stage approach. Twenty-five implants were placed immediately after extraction. Experimental concave titanium (n=49) and zirconia abutments (n=5) were used, and a provisional crown was placed at the same session. Digital photographs were made perpendicularly to the facial aspect of the teeth at abutment placement, and at 1, 3, 6, 12, 18, and 24 months, and enlarged views were subsequently analyzed by an independent examiner. Vertical changes in soft tissue levels were measured, and the definitive esthetic result was evaluated subjectively (poor to excellent). Data were analyzed with descriptive statistics. RESULTS: Twenty-four implants were evaluated at 24 months, 20 at 18 months, and 8 at 12 months. Vertical augmentation or no recession in soft tissue was observed in 87% of the situations, and in no situation was recession greater than 0.5 mm found. The gingival level remained stable at 12, 18, and 24 months. The average esthetic outcome was rated as 4.5 (very good to excellent) on a 0- to 5-point scale. CONCLUSIONS: The concave, gingivally converging abutments used in the study allowed for above-average soft tissue outcomes.