Novel bendable abutments as a solution to correct unfavorable implant inclination. A clinical report.

OBJECTIVE: This clinical case report describes a novel bendable abutment as a prosthetic solution for implants presenting with an unfavorable inclination. CLINICAL CONSIDERATIONS: A metal-ceramic screw-retained single crown was made on this novel bendable abutment in a patient presenting with a pronounced buccal inclination of an implant. A plastic reference guide is used to define the correct inclination and then this inclination is transferred to the abutment using a specific bending device at the same appointment. CONCLUSIONS: Bendable abutments can be used as a solution to correct unfavorable implant inclinations. This abutment can be customized at the same appointment considering a case-specific inclination rather than conventional pre-angled abutments. CLINICAL SIGNIFICANCE: Bendable abutments can be customized according to each case specificities while conventional pre-angled abutments may not be adequate for all patients. Also, the abutment customization could be easily done by dentists at their own practices using a specific bending device with hand pressure only, saving time, and the need to order pre-angled abutments or having it in stock.

Sequential healing at implants installed immediately into extraction sockets. An experimental study in dogs.

OBJECTIVE: To compare the sequential healing at implants installed in a healed alveolar bony ridge or immediately after tooth extraction without functional load. MATERIAL AND METHODS: In the mandible of 12 dogs, the mesial roots of the first molars were endodontically treated, the tooth hemisected, and the distal roots extracted. After 3 months, the mesial roots of the fourth premolars were endodontically treated, the tooth hemisected, and the distal roots extracted in one side of the mandible. Implants were placed immediately into extraction sockets (IPIES) of the fourth premolar and in the healed sites in the molar regions. Healing abutments were placed, and the flaps were sutured to allow a non-submerged healing. The time of surgery and of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2 weeks and 1 and 3 months, respectively. Ground sections were prepared for histological evaluation of tissues components on the implant surface and the coronal termination level of osseointegration (M-B). RESULTS: New bone apposition on the implant surface was slightly higher at the healed compared to the IPIES sites, being 7.4% and 4.1% after 1 week, and 67.3% and 65.3% after 3 months, respectively. Old bone was progressively resorbed, from 27.0% and 21.9% after 1 week, to 2.5% and 2.0% after 3 months, at healed and IPIES sites, respectively. M-B was 1.4 mm and 2.6 mm after 1 week, 1.2 mm and 1.2 mm after 3 months, at healed and IPIES sites, respectively. CONCLUSIONS: Similar patterns of sequential osseointegration were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extraction. The coronal termination level of osseointegration, that was different after 1 week, was found similar at the 3-month observation.

Stability of implants placed in fresh sockets versus healed alveolar sites: Early findings.

OBJECTIVES: The present study measured implant stability quotient (ISQ) values at three different time points after surgical procedures to compare whether the stability values differed between implants placed in fresh extraction sockets versus healed alveolar sites. MATERIALS AND METHODS: To measure implant stability, resonance frequency analysis (RFA) was performed in 77 patients (53 women, 24 men) with a total of 120 dental implants. These implants were divided into two groups: Group 1 included 60 implants in healed alveolar sites (22 in the maxilla, 38 in the mandible), and Group 2 included 60 implants in fresh sockets (41 in the maxilla, 19 in the mandible). Implant stability was measured immediately at implant placement (baseline), 90, and 150 days later. Statistical analysis was made using a multivariate regression linear model at implant level (α = 0.05). RESULTS: Overall, the means and standard deviations of the ISQ values were 62.7 ± 7.14 (95% confidence interval [CI], 39-88) at baseline, 70.0 ± 6.22 (95% CI, 46-88) at 90 days, and 73.4 ± 5.84 (95% CI, 58-88) at 150 days. In Group 1, the ISQs ranged between 64.3 ± 6.20 and 75.0 ± 5.69, while in Group 2, presented lower values that ranged between 61.2 ± 8.09 and 71.9 ± 5.99 (P = 0.002). Anatomic location and times periods were the only identified variables with an influence on ISQ values at implant level (P < 0.0001). CONCLUSIONS: The stabilities of the implants placed in the fresh sockets and in healed sites exhibited similar evolutions in ISQ values and thus osseointegration; however, the implants in the healed alveolar sites exhibited superior values at all time points.

Immediate loading of implants installed in a healed alveolar bony ridge or immediately after tooth extraction: an experimental study in dogs.

OBJECTIVE: To compare the sequential healing at immediately loaded implants installed in a healed alveolar bony ridge or immediately after tooth extraction. MATERIAL AND METHODS: In the mandible of 12 dogs, the second premolars were extracted. After 3 months, the mesial roots of the third premolars were endodontically treated and the distal roots extracted. Implants were placed immediately into the extraction sockets (test) and in the second premolar region (control). Crowns were applied at the second and third maxillary premolars, and healing abutments of appropriate length were applied at both implants placed in the mandible and adapted to allow occlusal contacts with the crowns in the maxilla. The time of surgery and time of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2 weeks and 1 and 3 months. Ground sections were prepared for histological analyses. RESULTS: At the control sites, a resorption of the buccal bone of 1 mm was found after 1 week and remained stable thereafter. At the test sites, the resorption was 0.4 mm at 1-week period and further loss was observed after 1 month. The height of the peri-implant soft tissue was 3.8 mm both at test and control sites. Higher values of mineralized bone-to-implant contact and bone density were seen at the controls compared with the test sites. The differences, however, were not statistically significant. CONCLUSIONS: Different patterns of sequential early healing were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extractions. However, three months after implant installation, no statistically significant differences were found for the hard- and soft-tissue dimensions.

Implantes dentários em alvéolos frescos posteriores com enxerto ósseo bovino e carga imediata: relato de um caso clínico com três anos de acompanhamento / Immediate implant placement and loading in fresh extraction sockets concomitant to particulate bovine grafting: a three-year follow-up case report

Este trabalho demonstra um caso clínico em que três raízes restauradas com coroas dentossuportadas foram perdidas devido a diferentes fatores – fratura radicular vertical invasão de espaço biológico, cárie radicular e doença periodontal – e substituídas por implantes dentários na mesma sessão da exodontia, com colocação de coroas provisórias imediatas e preenchimento dos espaços com osso xenógeno particulado. Novas coroas definitivas foram instaladas após dez meses, reestabelecendo a função mastigatória. Podemos considerar, de acordo com os resultados obtidos, que o protocolo apresentado foi adequado no caso relatado, com bons resultados no controle clínico e radiográfico em três anos de acompanhamento.

This paper presents a clinical case where three tooth-supported metalloceramic crowns failed due vertical root fracture, biologic width problems, and caries/periodontal disease, respectively. All elements were replaced at the same session by immediate-loaded dental implants and provisional crowns. The remaining spaces between implants and native bone were filled with particulate xenograft material. New definitive crowns were delivered 10 months later to reestablish masticatory function. According to the obtained results, one can consider that the presented protocol was adequate with excellent clinical and radiographic aspects over a three-year follow-up period.

Fatores locais relacionados à instalação de implantes imediatos em alvéolos de estração: revisão de literatura / Local factors related with placement of immediate implants into extraction sockets: literature review

A previsibilidade dos implantes dentários usando o protocolo tradicional de Branemark está bem sedimentada na literatura. Desde sua criação, este protocolo vem sendo progressivamente modificado visando à diminuição do tempo de tratamento e a redução do número de etapas cirúrgicas, maximizando o resultado estético das próteses sobre implantes. A partir da década de 80, do século passado, os implantes vêm sendo instalados imediatamente nos alvéolos de extração e, em alguns casos, podem receber uma prótese provisória no momento da cirurgia, melhorando ainda mais o conforto do paciente reabilitado com implantes orais. Após a aceitação da técnica dos implantes transalveolares imediatos pela comunidade científica, grandes benefícios para o clínico e principalmente para o paciente candidato à instalação de implantes foram viabilizados. Desta maneira, este artigo tem por objetivo apresentar uma revisão de literatura sobre os fatores que podem afetar a cicatrização de implantes instalados imediatamente, abordando também algumas manobras realizadas no tecido gengival para o fechamento primário do retalho sobre o leito do implante, nos casos onde não esta indicada a provisionalização imediata

The predictability of dental implants using Branemark’s traditional protocol is well documented in the literature. Since its creation, this protocol has been progressively modify to decrease the treatment time and reduce the number of surgeries, improvement the aesthetic result of implants prosthesis. Nowadays, the implants are placed immediately into extraction sockets and could receive a provisional in the surgery moment, improvement the comfort of rehabilitated patient with dental implants. After acceptance of transalveolar immediate implants by scientific community, many benefits to clinician and mainly to patient that will receive implants were achieved. The aim of this paper was present a literature review about factors that can effect the healing of immediate implants, approaching too procedures realized with gingival tissue to primary closure of flap onto implant in the cases without immediate provisional

Estágio atual do tratamento do espaço entre a parede óssea e a superfície do implante em alvéolos de extração: revisão de literatura / Actual stage of the space's treatment between bone wall and implant surface in extraction sockets: a literature review

Os implantes transalveolares imediatos têm sido apresentados como uma estratégia previsível de tratamento que permite minimizar a redução no volume ósseo após a perda dentária, podendo prevenir a atrofia severa do rebordo alveolar. Entretanto, nesta técnica freqüentemente permanece um espaço entre a superfície do implante e a parede óssea na porção coronária do alvéolo. Uma grande variedade de técnicas regenerativas é sugerida para viabilizar a formação óssea e melhorar a qualidade da osseointegração ao redor de implantes instalados em alvéolo de extração. O objetivo deste artigo é fazer uma revisão de literatura a respeito dos materiais e técnicas que vem sendo utilizados para tratar o espaço entre o leito ósseo e os implantes imediatos, bem como identificar as situações em que este tratamento é necessário

The placement of implants immediately after tooth extraction has proven to be predictable treatment strategy with a very high rate of success. The immediate transalveolar implants technique reduces the bone loss and preserve the height and width of the alveolar bone. Despite of this, a gap, between the implant surface and the coronal part of the buccal bone wall of the extraction socket, is present. A great variety of regenerative techniques have been used to allow the bone formation in the gape and the improve the quality of the osseointegration around those implants. The purpose of this article is to evaluate, through a literature review, the biomaterials and regenerative techniques that has been used to teat the gap as well to identify the indications of this treatment