Abstract

Purpose: The aim of this prospective clinical cohort study is to evaluate how the use of ovate pontic alongside alveolar ridge preservation (ARP) contributes to soft tissue preservation when placed immediately post-extraction into a socket with or without intact buccal bone plate in the esthetic zone.

Materials and Methods: Twenty-three patients with a non-restorable tooth in the max- illary esthetic zone bound by natural adjacent teeth were recruited for the study. At the time of extraction, patients were assigned to three groups, Group A (type I socket with ARP), B (type II socket with ARP), and C (type II socket with ARP and membrane). Following flapless extraction, an ovate pontic with ARP was placed. Impressions were taken before extraction, and at 3- and 6-month follow-up visits. Master casts were created to measure dimensional alterations. Descriptive statistical analysis compared changes in linear and volumetric measurements over the follow-up period.

Results: After 6 months, Group A showed mean dimensional changes of -1.28 ± 0.75 mm in width, -1.19 ± 0.61 mm in height, and -30.51 ± 17.55 mm3 in volume. Group B had changes of -1.07 ± 0.48 mm in width, -1.12 ± 0.51 mm in height, and -23.36 ± 7.74 mm3 in volume. Group C experienced changes of -1.43 ± 0.41 mm in width, -0.98 ± 0.32 mm in height, and -31.27 ± 9.59 mm3 in volume.

Conclusions: Utilization of an ovate pontic provisional restoration in conjunction with ARP minimizes post-extraction ridge alteration and maintains natural morphology, providing a stable prosthetic foundation for fixed restorations, regardless of bone plate presence.

Abstract
Full-arch implant therapy with immediate provisionalization is a popular procedure. Conventionally, chairside conversion of a prefabricated prosthesis or an abutment-level impression is usually required. This case report describes a novel approach to picking up a prefabricated full-arch prosthesis utilizing various digital techniques. After implant placement and bone reduction was performed using a customized surgical guide, a provisional restoration was seated on a stackable guide and relined with a light-cured material (the “liquid pin”). This material is strong enough to hold the titanium bases in place during the relining procedure yet can be quickly and completely removed from the titanium bases and multi-unit abutments following the pick-up. The liquid pin technique enables the provisional prosthesis to maintain its structural integrity, eliminates the need for a postoperative impression, and allows for minimal adjust- ment before delivery. Together with digital preplanning of the prosthesis, this technique streamlines the workflow for immediate full-arch provisionalization.

Abstract

Objective: To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis.

Material and Methods: Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose crosslinked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes.

Results: In total, 20 patients (nimplant=39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants.

Conclusion: The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Abstract

Objectives: These two clinical case reports show the use of the Triple Layer Graft procedure along with the Decoronation procedure to help restore normal contour and height of tissue The procedure was highly effective at restoring the esthetics that the patients needed on their implants. Short and long term results along with the step by step technique are shown.

Clinical Considerations: Two patients of 33 and 25 years of age both had significant reduction in the height over their implants in the #7 and #10 locations. The first patient had the implants placed 15 years ago and the second patient had them done 5 years before our treatment. Current techniques to remedy esthetic issues created by malpositioned implants consist of soft and/or hard tissue grafting but tend to be utilized independently of each other in discrete procedures as opposed to being combined in one surgical protocol. The Triple Layer Graft (TLG) surgical protocol is novel in that it incorporates all three layers of grafting to ad- dress both soft and hard tissue deficits in one procedure done at one time after doing a decoronation technique. The TLG surgical and prosthetic protocol has been previously published by these authors, but this article will discuss the rationale along with the technique and indications and contraindications, illustrated via case reports. The authors will also report on the long-term results of this technique.

Conclusions: The Triple Layer Graft TLG) in combination with the Decoronation technique is an effective method in managing mild as well as severe esthetic defects over the facial of previously placed implants.

Clinical Significance: The Triple Layer Graft will allow implants that were previously removed in order to place a new implant along with ridge augmentation may be able to be saved. This is a wonderful procedure for the patient since the implant does not have to be removed and replaced.

Abstract

Purpose: To determine the effect of restorations with long contact areas for the man- agement of interdental papilla deficiencies, in smile attractiveness among laypersons and dentists.

Material and Methods: A full-portrait image was used to create a set of digitally mod- ified images, simulating the management of various levels of interdental papilla loss. In a total of 48 modified images, single as well as multiple loss of interdental papilla among the anterior teeth, treated with a single or multiple restorations were simulated for unilateral and bilateral situations. Through a digital monitor 160 laypeople and dentists were asked to assess the attractiveness of each displayed image utilizing a visual-analog-scale. Multiple Wilcoxon-signed-rank tests followed by Mann–Whitney U tests were performed considering a significance level of 0.05.

Results: The management of an open gingival embrasure due to interdental papilla loss, by simulating the restoration of both central incisors led to a significantly higher mean smile attractiveness compared to the restoration of a single central incisor. Among the investigated regions, the management of open gingival embrasure in the area of central incisors using a restorative approach was perceived as the least esthetic (p < 0.05).

Conclusions: Despite the restorative management of interdental papilla loss, with the establishment of longer contact areas for the reduction of open gingival embrasures, as the level of the interdental papilla loss is increased, facial esthetics are compromised. When a longer contact area is accomplished through a single restoration, asymmetry among the teeth can be induced, especially in the region of the central incisors.

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Abstract

Purpose: Complications can and do occur with implants and their restorations withcauses having been proposed for some single implant complications but not for others.

Methods: A review of pertinent literature was conducted. A PubMed search of vibration, movement, and dentistry had 175 citations, while stress waves, movement, and dentistry had zero citations as did stress waves, movement. This paper discusses the physics of vibration, elastic and inelastic collision, and stress waves as potentially causative factors related to clinical complications.

Results: Multiple potential causes for interproximal contact loss have been presented, but it has not been fully understood. Likewise, theories have been suggested regarding the intrusion of natural teeth when they are connected to an implant as part of a fixed partial denture as well as intrusion when a tooth is located between adjacent implants, but the process of intrusion, and resultant extrusion, is not fully understood. A third complication with single implants and their crowns is abutment screw loosening with several of the clinical characteristics having been discussed but without determining the underlying process(es).

Conclusions: Interproximal contact loss, natural tooth intrusion, and abutment screw loosening are common complications that occur with implant retained restorations. Occlusion is a significant confounding variable. The hypothesis is that vibration, or possibly stress waves, generated from occlusal impact forces on implant crowns and transmitted to adjacent teeth, are the causative factors in these events. Since occlusion appears to play a role in these complications, it is recommended that occlusal contacts provide centralized stability on implant crowns and not be located on any inclined surfaces that transmit lateral forces that could be transmitted to an adjacent tooth and cause interproximal contact loss or intrusion. The intensity, form, and location of proximal contacts between a natural tooth located between adjacent single implant crowns seem to play a role in the intrusion of the natural tooth. Currently, there is a lack of information about the underlying mechanisms related to these occurrences and research is needed to define any confounding variables.

Purpose: To investigate the influence o f a s ingle i nfrapositioned a nkylosed t ooth o r i mplant-supported r estoration on smile esthetics. Materials and Methods: A series of 48 digitally modified images that simulated varying degrees of infraposition (from 0.25 to 2.0 mm, with a step of 0.25 mm) were created for each maxillary anterior tooth by altering the full-portrait image of a smiling man, adjusted to show medium and high smile lines. For the model with the high smile line, a series of 24 digitally modified images were created that simulated the infraposition of a single anterior tooth with a restored incisal edge. Smile esthetics for each of the images were evaluated by 160 participants (80 dentists and 80 laypersons), and a visual analog scale was implemented. Results: For the images with the high smile line, an infraposition of ≥ 0.25 mm in the central incisor’s region and ≥ 0.5 mm in the region of the lateral incisor or the canine had a negative effect on the perceived smile esthetics for both the dentists and the laypersons. Regarding the medium smile line, an infraposition of ≥ 0.5 mm in the central and lateral incisor region had a negative effect on the perceived smile esthetics for both groups of observers. In the canine area, an infraposition of ≥ 0.5 mm for the dentists and ≥ 0.75 mm for the laypersons also had a negative impact on the smile esthetics.

Conclusions: Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant-supported restoration can reduce the perceived attractiveness of the face. Infraposition in the canine site can be better tolerated in a medium smile line compared to a high smile line. In patients with a high smile line, prosthetic intervention is needed to restore the incisal edge of an infrapositioned tooth without harmonizing the gingival contour; this can be beneficial for the lateral incisor but ineffective for the central incisor and unfavorable for the canine. Int J Oral Maxillofac Implants 2024;39:xxx–xxx. doi: 10.11607/jomi.10749

The use of conventional scan bodies (SBs) with an intraoral scanner (IOS) to capture the position of a complete arch of dental implants has proven to be challenging. The literature is unclear about the accuracy of intraoral scanning techniques using SBs that are connected vertically to multiunit abutments (MUAs) for numerous adjacent implants in the same arch. Recently, there has been a paradigm shift from vertical SBs to horizontal SBs, which are positioned perpendicular to the long axis of the MUAs. Most IOSs available today can capture these horizontal SBs, called scan gauges (SGs), with better accuracy and consequently acquire the position of multiple adjacent implants using an effective scan path, thus reducing stitching and the number of images. The key to implementing this novel technology is to strategically arrange the SGs to optimize horizontal overlap of multiple adjacent SGs without touching each other. By superimposing two high-resolution intraoral scans of the SGs, an artificial intelligence (AI) algorithm is employed to produce a calibrated digital best-fit model on which a passive complete-arch prosthesis can be designed and fabricated. The advantages and disadvantages of SBs and SGs are discussed, and a case report using a digital workflow is presented.

Abstract

Objective: To develop a comprehensive decision-making tree for evaluating mid-facial peri-implant soft tissue dehiscence in the esthetic zone and provide a systematic approach for assessing various clinical case scenarios, determining appropriate treatment strategies, and considering factors such as the need for soft tissue augmentation, prosthetic changes, or implant removal.