Horizontal alveolar ridge augmentation: the importance of space maintenance.

At dental implantology's inception, patients seeking tooth or teeth replacement were confronted with the concern of whether they were viable "candidates" for treatment. Largely, this criteria was based on 3-dimensional bone volume present in edentulous sites selected for implant fixture insertion. When surgeons determined this volume as insufficient for implant placement, patients were encouraged to seek alternative restorative therapy. As the ability to regenerate lost tissue, both hard and soft, has evolved, the number of patients now considered "candidates" for implant therapy has increased exponentially. Not only has the ability to regenerate lost hard tissue improved, but it has facilitated prosthetically and mechanically favorable implant positioning. This has led to decreases in mechanical and biologic complications. The efficacy of augmentation techniques has been critically evaluated, and minimizing morbidity while improving outcomes is a goal shared by surgeons and patients alike. This article discusses several methods of hard-tissue augmentation and presents a novel technique of regeneration aimed at improving clinical outcomes while decreasing morbidity associated with older, yet effective modes of ridge augmentation.

Implant-assisted overdenture: a case report.

A patient's extreme susceptibility to periodontal disease, likely exacerbated by a history of smoking, resulted in severe periodontal breakdown. Employing a systematic approach that identified both patient risk and prognosis using data gathered during the patient examination, a treatment plan was developed that included extraction of structurally compromised teeth and the use of implant-assisted complete overdentures. This treatment approach accomplished a reduction of biomechanical, periodontal, and dentofacial risk, as well as an increase in functional harmony.

[Zirconia in removable prosthodontics. A case report]. / Zirconiumdioxid in der abnehmbaren Prothetik. Ein Fallbericht.

Zirconia as a framework material is well established in fixed prosthodontics. However, for its application for removable dentures little experience exists. Zirkonzahn® has developed a copy-milling unit, that is a manually operated machine for the manufacture not only of frameworks but also of complete removable dentures. The aim of this case report is to show the step-by-step clinical and technical fabrication of a zirconia bar on implants and of a corresponding zirconia complete denture. The advantages and disadvantages of the system are presented and problems are critically discussed.

[Control of generalized chronic periodontitis combined with calcium-antagonist-related gingival overgrowth by a complex periodontal-endodontic-prosthodontic treatment. Case report]. / Ca-csatorna-blokkoló antihipertenzív gyógyszert szedo, generalizált krónikus parodontitisben szenvedo nobeteg komplex parodontális-protetikai ellátása. Esetismertetés.

To day a relatively high percentage of elderly population of the industrialized world suffers with different cardiovascular diseases and are on permanent antihypertensive therapy. One of the most frequently used drugs is the calcium channel blockers prescribed against high blood pressure. The most common oral side effect of these drugs is the gingival enlargement that might develop even on otherwise healthy gingiva. The incidence of chronic periodontitis in this age group is also high and the Ca antagonist medication in those individuals might substantially modify the clinical course of periodontal inflammation leading to gingival enlargement and hypertrophic pocket wall. The case presented here is a 52 years old hypertonic woman with a long history of Ca-antagonist therapy and generalized chronic periodontitis combined with gingival hyperplasia. After the change of medication the 1,5 years comprehensive periodontal endodontic and prosthodontic therapy restored patient's periodontal health and provided complex dental rehabilitation. Nevertheless, only regular periodontal supportive therapy could ensure predictable outcome and guarantee long lasting periodontal health.

A retrospective study of edentulous patients rehabilitated according to the 'all-on-four' or the 'all-on-six' immediate function concept using flapless computer-guided implant surgery.

PURPOSE: To report the outcome of an implant therapy protocol using 4 or 6 implants supporting immediately loaded fixed prostheses following 3D software planning and flapless guided surgery. MATERIALS AND METHODS: A total of 30 patients (24 women, 6 men), mean age of 53 years (range 35-84 years) were treated with 195 immediately loaded implants (97 NobelSpeedy Groovy and 98 Brånemark MKIII Groovy) supporting 25 maxillary and 17 mandibular fixed full-arch acrylic prostheses and followed for 1 year. The Procera Software v1.6 and v2.0 was used to plan implant position and to obtain a surgical template for the guided flapless implant placement. To perform immediate loading, the implants had to be inserted with torque of at least 35 Ncm. Provisional prostheses were made before surgery using software planning and were placed in the same session as the implants. Definitive restorations were delivered 6-12 months after surgery. Outcome measures were failures of the prosthesis and of the implants, marginal bone level changes, complications, clinical time and patient satisfaction. RESULTS: Four patients with full edentulism and 26 with advanced periodontitis were enrolled in this study. A total of 195 implants were immediately loaded (128 implants were placed in the maxilla and 67 implants were placed in the mandible). Four implants out of 195 failed in three patients during the healing period: 2 in the maxilla (1 straight and 1 tilted), and 2 in the mandible (both of them tilted). Three of them were successfully replaced. One year after loading there were no dropouts and no failure of the definitive prosthesis occurred. In three cases, the surgical template fractured during surgery. In one patient, a new impression had to be taken to fit the provisional prosthesis onto the implants. Three patients were subjected to surgery and systemic antibiotics to treat apically infected implants. CONCLUSIONS: The 'all-on-four' and 'all-on-six' treatment protocol combined with computer-guided flapless implant surgery could be a viable and predictable treatment. Some complications occurred that were successfully treated. However, this technique could be sensitive to the experience of the surgeon and a learning curve is required.

Five-year study of implant placement in regenerated bone and rehabilitation with telescopic crown retained dentures: a case report.

Various implant-supported restorations have been used successfully for several decades to rehabilitate edentulous patients. Telescopic crowns are a common treatment modality used to connect dentures to natural teeth. Although previous findings indicate that telescopic crowns can be placed successfully on implants to support overdentures, only limited data are available on this treatment approach. Eight months after extraction of all nonsalvageable teeth and socket preservation, 11 implants were inserted into the mandible and maxillae of one patient. These implants were restored 4 months later using telescopic crown-supported dentures. Bleeding on probing (BOP), plaque index (PI), clinical attachment (PAL), and radiographic bone level were evaluated over 5 years. All implants remained in function over the 5-year evaluation period. Radiography showed stable bone levels for all implants. No changes in BOP or PI (range, 2%-4% for both parameters) were observed over this time. The PAL deteriorated by 1.5 mm during the first 3 years, with no subsequent changes. We conclude that telescopic crowns can be used successfully as attachments for overdentures supported by implants in regenerated bone.

Rehabilitation of a periodontally compromised case using the conical crown system. Part I.

The aim of this two-part treatment series is on the one hand to emphasize the difficulties and dilemmas a dentist is confronted with when planning complex cases, and on the other hand to reveal the rationale supporting the final treatment plan selection. Challenging cases are considered, including, among others, periodontal compromised rest dentitions requiring prosthodontic rehabilitation. For these patients the decision-making process deals with the indications and limitations of both the fields of fixed and removable prosthodontics. The first part of this study deals with the various prosthodontic treatment options together with the advantages and disadvantages related to each one. The second part of the article presents the final treatment-plan, the decision-making process and the sequence of the treatment steps.

Rehabilitation of a periodontally compromised case using the conical crown system. Part II.

The aim of this two-part treatment series is on the one hand to emphasize the difficulties a clinician is confronted with when planning complex cases, and on the other hand to reveal the rationale supporting the final treatment plan selection. Among the challenging cases to be considered are periodontal compromised rest dentitions requiring prosthodontic rehabilitation. For these patients the decision-making process deals with the indications and limitations of both the fields of fixed and removable prosthodontics. The first part of this article deals with the various prosthodontic treatment options, together with the advantages and disadvantages related to each one. This second part of the article presents the final treatment plan, the decision-making process, and the sequence of the treatment steps.